Page: 1

Branch : Andheri East, Unit No.15, OPTIONS PRIMO, Plot No.X-21, Cross Road No.21, MIDC,Andheri(Esat),Mumbai - 400093 MUMBAI Maharashtra INDIA 400093

Name: BAJAJ ALLIANZ LIFE INSURANCE COMPANY LIMITED Branch IFSC Code : ESMF0001148
Address: GORUND FLOOR 2 6 FLOOR BAJAJ ALLIANZ Account Number : 20180000024486
HOUSE AIRPORT ROAD YERAWADA Branch of Ownership : Andheri East
YERAWADA 411006 Branch MICR Code : 400760002
MAHARASHTRA INDIA Date Opened : 10/12/2018
Signatories: MR. SHAM YASHWANT TANAWADE (AUTH.SIGN.) Activation Date : 20/12/2018
MR. ANAND GANDHI (AUTH.SIGN.) Currency Code : INR
MR. RAJAT KAPOOR (AUTH.SIGN.) Account Status : Active

Statement of Account
From:01/01/2024 To:30/01/2024
Date Effective Cheque Number Description Withdrawal Deposit Amt. Balance
Date Amt.
01/01/2024 01/01/2024 WITHDRAWAL,ACH Debit-BAJAJ ALLIANZ LIFE I- 1,00,00,000.00 11,67,666.76
ESAF0000000000022815-INV01012024_5-9006470721
01/01/2024 01/01/2024 WITHDRAWAL,ACH Debit-BAJAJ ALLIANZ LIFE I- 11,00,000.00 67,666.76
ESAF0000000000022815-INV01012024_6-9006470722
01/01/2024 DEPOSIT,RETAIL LOAN INSURANCE DECEMBER 9,63,758.00 10,31,424.76
302023 COUNT108
01/01/2024 DEPOSIT,Bajaj 30 December 2023PREMIUM AMOUNT 55,20,767.40 65,52,192.16
IGL Count6576GL220 MFIG Count1318VJL2JEEVADH
01/01/2024 01/01/2024 FEE CHG,WTHDRL FEES/SMS/1/2024/Dec 10.09 65,52,182.07
02/01/2024 02/01/2024 WITHDRAWAL,ACH Debit-BAJAJ ALLIANZ LIFE I- 64,00,000.00 1,52,182.07
ESAF0000000000022815-INV02012024_6-9047784930
02/01/2024 DEPOSIT,Bajaj 01 January 2024PREMIUM AMOUNT 21,98,763.40 23,50,945.47
IGL Count3058GL191 MFIG Count156VJL11JEEVADHA
03/01/2024 DEPOSIT,Bajaj 02 January 2024PREMIUM AMOUNT 28,51,618.20 52,02,563.67
IGL Count3952GL184 MFIG Count346VJL10JEEVADHA
03/01/2024 DEPOSIT,RETAIL LOAN INSURANCE JANUARY 1,75,599.00 53,78,162.67
012023 COUNT10
04/01/2024 04/01/2024 WITHDRAWAL,ACH Debit-BAJAJ ALLIANZ LIFE I- 52,00,000.00 1,78,162.67
ESAF0000000000022815-INV04012024_6-9149598967
04/01/2024 DEPOSIT,Bajaj 03 January 2024PREMIUM AMOUNT 29,11,499.60 30,89,662.27
IGL Count4086GL181 MFIG Count208VJL4JEEVADHAR
04/01/2024 DEPOSIT,RETAIL LOAN INSURANCE JANUARY 1,87,013.00 32,76,675.27
02032023 COUNT22
05/01/2024 05/01/2024 WITHDRAWAL,ACH Debit-BAJAJ ALLIANZ LIFE I- 31,00,000.00 1,76,675.27
ESAF0000000000022815-INV05012024_5-9201652872
05/01/2024 DEPOSIT,Bajaj 04 January 2024PREMIUM AMOUNT 28,57,313.12 30,33,988.39
IGL Count4018GL164 MFIG Count194VJL8JEEVADHAR
05/01/2024 DEPOSIT,RETAIL LOAN INSURANCE JANUARY 96,418.00 31,30,406.39
042023 COUNT14
06/01/2024 DEPOSIT,RETAIL LOAN INSURANCE JANUARY 2,01,152.00 33,31,558.39
052023 COUNT19
06/01/2024 DEPOSIT,Bajaj 05 January 2024PREMIUM AMOUNT 33,95,439.80 67,26,998.19
IGL Count4604GL125 MFIG Count478VJL5JEEVADHAR
06/01/2024 DEPOSIT,VVY LOAN INSURANCE 25122023 TO 28,696.00 67,55,694.19
31122023COUNT50
08/01/2024 08/01/2024 WITHDRAWAL,ACH Debit-BAJAJ ALLIANZ LIFE I- 66,00,000.00 1,55,694.19
ESAF0000000000022815-INV08012024_5-9301950508
08/01/2024 DEPOSIT,Bajaj 06 January 2024PREMIUM AMOUNT 53,85,552.16 55,41,246.35
IGL Count6760GL352 MFIG Count450VJL16JEEVADHA
08/01/2024 DEPOSIT,RETAIL LOAN INSURANCE JANUARY 3,00,259.00 58,41,505.35
062023 COUNT30
09/01/2024 09/01/2024 WITHDRAWAL,ACH Debit-BAJAJ ALLIANZ LIFE I- 57,00,000.00 1,41,505.35
ESAF0000000000022815-INV09012024_6-9346348654
09/01/2024 DEPOSIT,RETAIL LOAN INSURANCE JANUARY 1,96,218.00 3,37,723.35
082023 COUNT11
09/01/2024 DEPOSIT,Bajaj 08 January 2024PREMIUM AMOUNT 23,97,363.40 27,35,086.75
IGL Count3290GL176 MFIG
Count160VJL5JEEVADHARBajaj 08 Jan
10/01/2024 10/01/2024 WITHDRAWAL,ACH Debit-BAJAJ ALLIANZ LIFE I- 26,00,000.00 1,35,086.75
ESAF0000000000022815-INV10012024_5-9404948606
10/01/2024 DEPOSIT,RETAIL LOAN INSURANCE JANUARY 2,32,654.00 3,67,740.75
092023 COUNT22
10/01/2024 DEPOSIT,Bajaj 09 January 2024PREMIUM AMOUNT 20,41,914.20 24,09,654.95
IGL Count3078GL169 MFIG Count82VJL6JEEVADHARA
11/01/2024 11/01/2024 WITHDRAWAL,ACH Debit-BAJAJ ALLIANZ LIFE I- 23,00,000.00 1,09,654.95
ESAF0000000000022815-INV11012024_4-9484946619
11/01/2024 DEPOSIT,RETAIL LOAN INSURANCE JANUARY 2,44,643.00 3,54,297.95
102023 COUNT21

Unless the constituent notifies the Bank of any discrepancy in this statement within 15 days from the date of statement, it will be construed that this transaction(s) in the statement are
correct.This is a computer generated statement requires no signature.
 Page: 2

Branch : Andheri East, Unit No.15, OPTIONS PRIMO, Plot No.X-21, Cross Road No.21, MIDC,Andheri(Esat),Mumbai - 400093 MUMBAI Maharashtra INDIA 400093

Name: BAJAJ ALLIANZ LIFE INSURANCE COMPANY LIMITED Branch IFSC Code : ESMF0001148
Address: GORUND FLOOR 2 6 FLOOR BAJAJ ALLIANZ Account Number : 20180000024486
HOUSE AIRPORT ROAD YERAWADA Branch of Ownership : Andheri East
YERAWADA 411006 Branch MICR Code : 400760002
MAHARASHTRA INDIA Date Opened : 10/12/2018
Signatories: MR. SHAM YASHWANT TANAWADE (AUTH.SIGN.) Activation Date : 20/12/2018
MR. ANAND GANDHI (AUTH.SIGN.) Currency Code : INR
MR. RAJAT KAPOOR (AUTH.SIGN.) Account Status : Active

Statement of Account
From:01/01/2024 To:30/01/2024
11/01/2024 DEPOSIT,Bajaj 10 January 2024PREMIUM AMOUNT 94,24,502.40 97,78,800.35
IGL Count12594GL377 MFIG Count1068VJL1JEEVADH
11/01/2024 DEPOSIT,VVY LOAN INSURANCE 01012024 TO 58,385.00 98,37,185.35
07012024COUNT82
12/01/2024 12/01/2024 WITHDRAWAL,ACH Debit-BAJAJ ALLIANZ LIFE I- 97,00,000.00 1,37,185.35
ESAF0000000000022815-INV12012024_5-9513368366
12/01/2024 DEPOSIT,Bajaj 11 January 2024PREMIUM AMOUNT 28,76,738.40 30,13,923.75
IGL Count4084GL243 MFIG Count182VJL0JEEVADHAR
12/01/2024 DEPOSIT,RETAIL LOAN INSURANCE JANUARY 97,055.00 31,10,978.75
112023 COUNT19
15/01/2024 15/01/2024 WITHDRAWAL,ACH Debit-BAJAJ ALLIANZ LIFE I- 30,00,000.00 1,10,978.75
ESAF0000000000022815-INV15012024_5-9571052029
15/01/2024 DEPOSIT,RETAIL LOAN INSURANCE JANUARY 2,02,989.00 3,13,967.75
122023 COUNT28
15/01/2024 DEPOSIT,Bajaj 12 January 2024PREMIUM AMOUNT 81,35,451.40 84,49,419.15
IGL Count10184GL431 MFIG Count840VJL0JEEVADHA
16/01/2024 16/01/2024 WITHDRAWAL,ACH Debit-BAJAJ ALLIANZ LIFE I- 83,00,000.00 1,49,419.15
ESAF0000000000022815-INV16012024_4-9590917965
16/01/2024 DEPOSIT,RETAIL LOAN INSURANCE JANUARY 50,049.00 1,99,468.15
152023 COUNT13
16/01/2024 DEPOSIT,Bajaj 15 January 2024PREMIUM AMOUNT 14,95,931.80 16,95,399.95
IGL Count2188GL39 MFIG Count200VJL0JEEVADHARA
17/01/2024 17/01/2024 WITHDRAWAL,ACH Debit-BAJAJ ALLIANZ LIFE I- 15,00,000.00 1,95,399.95
ESAF0000000000022815-INV17012024_4-9615470108
17/01/2024 DEPOSIT,RETAIL LOAN INSURANCE JANUARY 1,86,277.00 3,81,676.95
162023 COUNT18
17/01/2024 DEPOSIT,Bajaj 16 January 2024PREMIUM AMOUNT 75,35,862.72 79,17,539.67
IGL Count9864GL390 MFIG Count538VJL0JEEVADHAR
18/01/2024 18/01/2024 WITHDRAWAL,ACH Debit-BAJAJ ALLIANZ LIFE I- 78,00,000.00 1,17,539.67
ESAF0000000000022815-INV18012024_4-9639418084
18/01/2024 DEPOSIT,RETAIL LOAN INSURANCE JANUARY 92,471.00 2,10,010.67
172023 COUNT16
18/01/2024 DEPOSIT,Bajaj 17 January 2024PREMIUM AMOUNT 38,70,626.40 40,80,637.07
IGL Count5456GL221 MFIG Count220VJL13JEEVADHA
19/01/2024 19/01/2024 WITHDRAWAL,ACH Debit-BAJAJ ALLIANZ LIFE I- 39,00,000.00 1,80,637.07
ESAF0000000000022815-INV19012024_4-9660946270
19/01/2024 DEPOSIT,RETAIL LOAN INSURANCE JANUARY 1,26,980.00 3,07,617.07
182023 COUNT24
19/01/2024 DEPOSIT,Bajaj 18 January 2024PREMIUM AMOUNT 42,21,821.00 45,29,438.07
IGL Count6158GL256 MFIG Count264VJL10JEEVADHA
20/01/2024 DEPOSIT,VVY LOAN INSURANCE 08012024 TO 27,722.00 45,57,160.07
14012024COUNT66
20/01/2024 DEPOSIT,Bajaj 19 January 2024PREMIUM AMOUNT 69,62,149.60 1,15,19,309.67
IGL Count9550GL461 MFIG Count468VJL1JEEVADHAR
22/01/2024 DEPOSIT,Bajaj 20 January 2024PREMIUM AMOUNT 88,14,774.80 2,03,34,084.47
IGL Count10636GL548 MFIG Count1016VJL2JEEVADH
22/01/2024 DEPOSIT,RETAIL LOAN INSURANCE JANUARY 4,26,857.00 2,07,60,941.47
19202023 COUNT50
23/01/2024 23/01/2024 WITHDRAWAL,ACH Debit-BAJAJ ALLIANZ LIFE I- 1,00,00,000.00 1,07,60,941.47
ESAF0000000000022815-INV23012024_5-9738116750
23/01/2024 23/01/2024 WITHDRAWAL,ACH Debit-BAJAJ ALLIANZ LIFE I- 1,00,00,000.00 7,60,941.47
ESAF0000000000022815-INV23012024_6-9738116751
23/01/2024 23/01/2024 WITHDRAWAL,ACH Debit-BAJAJ ALLIANZ LIFE I- 6,00,000.00 1,60,941.47
ESAF0000000000022815-INV23012024_7-9738116752
23/01/2024 DEPOSIT,Bajaj 22 January 2024PREMIUM AMOUNT 20,56,928.80 22,17,870.27
IGL Count2748GL193 MFIG Count106VJL0JEEVADHAR
23/01/2024 DEPOSIT,RETAIL LOAN INSURANCE JANUARY 1,56,138.00 23,74,008.27
222023 COUNT10
24/01/2024 24/01/2024 WITHDRAWAL,ACH Debit-BAJAJ ALLIANZ LIFE I- 21,00,000.00 2,74,008.27
ESAF0000000000022815-INV24012024_6-9754290790

Unless the constituent notifies the Bank of any discrepancy in this statement within 15 days from the date of statement, it will be construed that this transaction(s) in the statement are
correct.This is a computer generated statement requires no signature.
 Page: 3

Branch : Andheri East, Unit No.15, OPTIONS PRIMO, Plot No.X-21, Cross Road No.21, MIDC,Andheri(Esat),Mumbai - 400093 MUMBAI Maharashtra INDIA 400093

Name: BAJAJ ALLIANZ LIFE INSURANCE COMPANY LIMITED Branch IFSC Code : ESMF0001148
Address: GORUND FLOOR 2 6 FLOOR BAJAJ ALLIANZ Account Number : 20180000024486
HOUSE AIRPORT ROAD YERAWADA Branch of Ownership : Andheri East
YERAWADA 411006 Branch MICR Code : 400760002
MAHARASHTRA INDIA Date Opened : 10/12/2018
Signatories: MR. SHAM YASHWANT TANAWADE (AUTH.SIGN.) Activation Date : 20/12/2018
MR. ANAND GANDHI (AUTH.SIGN.) Currency Code : INR
MR. RAJAT KAPOOR (AUTH.SIGN.) Account Status : Active

Statement of Account
From:01/01/2024 To:30/01/2024
24/01/2024 DEPOSIT,Bajaj 23 January 2024PREMIUM AMOUNT 59,29,911.12 62,03,919.39
IGL Count7808GL346 MFIG Count448VJL3JEEVADHAR
25/01/2024 DEPOSIT,Bajaj 24 January 2024PREMIUM AMOUNT 50,51,970.32 1,12,55,889.71
IGL Count6728GL289 MFIG Count582VJL17JEEVADHA
25/01/2024 DEPOSIT,VVY LOAN INSURANCE 15012024 TO 61,752.25 1,13,17,641.96
21012024COUNT80
25/01/2024 DEPOSIT,RETAIL LOAN INSURANCE JANUARY 1,96,806.00 1,15,14,447.96
232023 COUNT23
29/01/2024 DEPOSIT,Bajaj 25 January 2024PREMIUM AMOUNT 77,32,944.60 1,92,47,392.56
IGL Count10346GL366 MFIG Count806VJL11JEEVADH
29/01/2024 DEPOSIT,RETAIL LOAN INSURANCE JANUARY 24 2,69,409.00 1,95,16,801.56
252023 COUNT58
30/01/2024 30/01/2024 WITHDRAWAL,ACH Debit-BAJAJ ALLIANZ LIFE I- 1,00,00,000.00 95,16,801.56
ESAF0000000000022815-INV30012024_11-9848697099
30/01/2024 30/01/2024 WITHDRAWAL,ACH Debit-BAJAJ ALLIANZ LIFE I- 94,00,000.00 1,16,801.56
ESAF0000000000022815-INV30012024_12-9848697100
30/01/2024 DEPOSIT,Bajaj 29 January 2024PREMIUM AMOUNT 49,97,718.40 51,14,519.96
IGL Count7382GL305 MFIG Count310VJL4JEEVADHAR

Statement Summary:-
Opening Balance Dr Count Cr Count Debits Credits Closing Balance
1,11,67,666.76 22 46 11,93,00,010.09 11,32,46,863.29 51,14,519.96

Unless the constituent notifies the Bank of any discrepancy in this statement within 15 days from the date of statement, it will be construed that this transaction(s) in the statement are
correct.This is a computer generated statement requires no signature.