Shriram Life Insurance Company Limited

IRDAI No : 128

PROPOSAL DEPOSIT RECEIPT

Proposer Name: Mr.PANKAJ SHARMA

Receipt No. : 520520240107248

6/283 BALENGANJ RANIWALA
GHERA BELANGANJ
Proposal No. : 520524004606
AGRA
Agent Code : S1677309
AGRA
Plan Name : SHRIRAM LIFE ASSURED SAVINGS
BELAN GANJ PLAN V03 POS

AGRA - 282004

UTTAR PRADESH - India

Payment Details
By Cheque No. Inst. Dt Bank Place Amount

NetBank 27012024SLQR1270 27/01/2024 15675.00

Total 15675.00

Received Rupees Fifteen Thousand Six Hundred Seventy Five Rupee(s) And Zero Paise Only. towards

Proposal Deposit Receipt from the above named Proposer

Kindly note that this receipt is only an acknowledgement for having received the amount as stated above and does not constitute
acceptance of risk cover under the proposal/policy

Tax Benefit as per the provisions of Income Tax Act 1961 subject to cheque realization and policy issuance.

Date & Time : 27/01/2024 00:00:00

Place : HYDERABAD
GACHIBOWLI

The validity of the receipt is subject to realization of Cheque,in case the payment is made by cheque

DISCLAIMER

* This receipt is auto-generated via Mobile App and the receipt being shared is a token acknowledgement and subject to premium
realisation on banking of premiums.

Signature Of Cashier

Regd office :5th Floor, Ramky Selenium,Plot No.31-32, Financial District ,(Beside Andhra Bank Training Center),Gachibowli,Hyderabad - 500032

Phone :040-23009400,Fax :. Toll Free No.: 1800-3000-6116