Health Companion Premium Receipt

Dear MR. MAHESH REDDY G

FLAT 74, STREET NO - 15, SRI RAM HILLS
KHAMMAM
TELANGANA - 507001

We acknowledge the receipt of payment towards the premium of the following health insurance policy:

Policy Holder's Name Mr. Mahesh Reddy G Policy Number 31620506202301

# 29/05/2023 28/05/2024
Policy Commencement Date Policy Expiry Date

Plan Opted for HC VARIANT 2 5L DED 5L NAT 2A

Net Premium/Taxable Value (INR) 11,074.00

Integrated Goods and Service Tax (18.00 %) (INR) 1,993.32

Central Goods and Service Tax (0.00 %) (INR) 0.00

State/Union Territory Goods and Service Tax (0.00 %) (INR) 0.00

Loading (INR) 0.00

Gross Premium (INR) 13,067.00

#
Issuance of policy is subject to clearance of premium paid

Details of persons Insured:

Name of Person Insured Age Gender Relationship with Proposer

Mr. Chitta Srinivasa Reddy 56 Male Father-in-law

Mrs. Chitta Saraswathi 45 Female Spouse

Upon issuance of this receipt, all previously issued temporary receipts, if any, related to this policy are considered null and void. For the
purpose of deduction under section 80D of the income Tax Act, 1961, please consult your tax advisor for more details. The benefit shall be as
per the provisions of the Income Tax Act, 1961 and any amendments made thereafter.

In the event of non-realization of premium, Tax benefits cannot be obtained against this premium receipt

GSTI No.: 09AAFCM7916H1Z6 SAC Code / Type of Service : 997133 / General Insurance Services

Niva Bupa State Code: 9 Customer State Code / Customer GSTI No.: 36 /NA

Policy issuing office: Delhi, Consolidated Stamp Duty deposited as per the order of Government of National Capital Territory of Delhi.

Location: New Delhi Director - Operations & Customer Service

Date: 04/06/2023 For and on behalf of Niva Bupa Health Insurance Company Limited
(formerly known as Max Bupa Health Insurance Co. Ltd.)

Product Name: Health Companion, Product UIN: NBHHLIP23108V062223