RENEWAL PREMIUM RECEIPT

Receipt No: Z9961959 Client ID: 58024147 Date: 10/09/2013

Policy No: 14573554 Plan Description: HDFCSL Classic Assure

Koppisetty, Ashok
Sahrat 3-128 Itud Lane
Sarada Nagar
Baligattam Narsipatnam
Visahapatnam - 531116
9550820019 /9550297590

Dear Koppisetty, Ashok Sahrat

Life Assured : Koppisetty, Ashok Sahrat

We acknowledge with thanks, receipt of an amount of Rs. ******12,186.00 by Online Payment towards renewal premium. as
regular premium towards your policy

Benefit Opted For Premium Received(Rs) Tax benefit available under the Income Tax Act, 1961
Classic Assure Benefit 12,000.00 Section 80C
Service tax and levies 186

For HDFC Standard Life Insurance Company Limited Renewal Premium Rs. ******12,186.00
Total Amount Received Rs. ******12,186.00
Balance Amount adjusted Rs. ***********0.00
*This is an electronically generated duplicate Advance Payment received Rs. ***********0.00
premium receipt and does not require any signature
Premium adjusted for the period to
Next premium due 29/08/2014
Premium payment frequency Annual
Service Tax Registration Number M-IV / ST / IAS - LIFE / 2
HDFC STANDARD LIFE INSURANCE COMPANY LIMITED
Correspondence Address: 11th Floor, Lodha Excelus, Apollo Mills Compound, N .M. Joshi Road, Mahalaxmi,
Mumbai- 400011.
Regd. Office: Lodha Excelus, 13th Floor, Apollo Mills Compound, N.M. Joshi Marg, Mahalaxmi, Mumbai - 400 011.
Maharashtra, India
Policy Servicing Helpline: 1800-228-228 (Toll free - MTNL/BSNL)/1800-209-7777(Toll Free - Any Phone) or 60007777
(Local call - Non BSNL/MTNL)