STATEMENT OF PREMIUMS PAID FOR THE PERIOD 01-APR-2023 to 31-MAR-2024

Client Id: 5012434566 Date: 23-JAN-2024

Name: Mr. Rishabh Gupta PAN: AOFPG2078D
Address: C/O Ajay Kumar Gupta L1602, Jasmine Grove Nh24
Near Wave City Ghaziabad - 201001
Uttar Pradesh, India
Mobile No.: 9650059342
Email Id: rishabhgupta23071987@gmail.com

Policy No. Plan Premium Premium Payment Policy

Amount # * (Rs.) Frequency Commencement Date
325114361 Max Life Online Term Plan Plus CO New 9,761.00 Monthly 29-NOV-2019
615882230 Max Life Online Health Insurance Plan CO New 50,000.00 Yearly 18-APR-2023
Total 59,761.00

INTEREST ON LATE PAYMENT (only in case of non-linked plans) : 0.00

Note: || # The Premiums mentioned in this document are subject to realization of the cheques/instruments/monies. || *The total premium amount is inclusive of
IGST/CGST/SGST as may be applicable. || This statement summarizes premiums paid by you in the specified period and is being used in addition to the receipts
which we have already issued and sent to you on your payment of premiums || Above premiums may be eligible for tax benefit under Section 80C / 80CCC
/ 80D of Income Tax Act 1961.Tax benefits as mentioned in the policy are subject to prevailing tax laws, which are subject to change. You are advised to seek
the opinion of your tax advisor in relation to applicable tax benefits and liabilities.
I/We hereby declare that though our turnover is more than the turnover notified under sub-rule (4) of rule 48, we are not required to prepare an invoice in terms
of the said sub-rule.
To serve you better, we request you to please update your email id and latest contact number by clicking https://bit.ly/2O4S2VT or you can email the
change request at service.helpdesk@maxlifeinsurance.com

CON23 V2.0 19012023