Bajaj Allianz Life Insurance Co.

Ltd

Collected At: 7TH FLOOR, PLOT NO 4, DLF TOWER ~MOTI NAGAR SHIVAJI MARG WEST DELHI 110015

Application Number: 6121843124 Receipt No: 1107555228 Receipt Date & Time: 21/03/2023 13:13:30

Receipt Type: Proposal Deposit Received with thanks from: RAVINDER PAL SINGH

Policy Number: - Policy holder's Name: RAVINDER PAL SINGH

IC Code: 1003268756 IC Name: PRIYA DAGUR

SM Code: 1500131001 SM Name: ANKUR PRATAP SINGH

Sub Code: - Sub Name: -

Amount in Number: 100000.00 Paymode: Cheque

Amount in words: Rupees One Lakh Only

CHQ No./DD No. 804714 Date: 18/03/2023

Bank Name: PUNJAB NATIONAL BANK DAGSHAI DISTT SOLAN (HP) DAGSHAI

Thank you for choosing the auto-pay option for your future premium payments. Request you to submit the form for commencing auto-
pay, for hassle free and timely renewal payments, at our branch closest to you.
Disclaimer:Insurance cover shall commence only from the date of acceptance of risk, based on proposal papers submitted and other requirements called for. Insurance cover shall
resume only from the date of reinstatement of the policy. In case of outstation cheque, NAV will be as per the unit price of the date of realization of the cheque. Your contact number
and mail id registered with us is as below:

Contact Number: 9811200919 Email:

For eligibility under section 80C/80D of income Tax Act,1961. Please refer to relevant provisions and rules.

This is system Generated Receipt hence requires no signature.

Receipt is subject to realization of negotiable instrument / Bankers instruction.

BEWARE OF SPURIOUS PHONE CALLS AND FICTITIOUS/FRAUDULENT OFFERS IRDAI clarifies to public that - IRDAI or its officials do not involve in activities like sale of any kind
of insurance or financial products nor invest premiums. IRDAI does not announce any bonus. Public receiving such phone calls are requested to lodge a police complaint along
with details of phone call, number.

Regd. Office Address : Bajaj Allianz Life Insurance Co. Ltd., Bajaj Allianz House, Airport Road, Yerwada, Pune - 411006., IRDAI Reg No. : 116, Visit : www.bajajallianzlife.com,
CIN:U66010PN2001PLC015959, Mail us:customercare@bajajallianz.co.in, call on : Toll free no. 1800 209 7272, Fax No : 02066026789. The logo of Bajaj Allianz Life Insurance Co. Ltd.
is provided on the basis of license given by bajaj Finserv Ltd. to use its Bajaj Logo and Allianz SE to use its Allianz logo.By submitting your contact details or responding to Bajaj
Allianz Life Insurance Co. Ltd., with an SMS or Missed Call, you authorised Bajaj Allianz Life Insurance Co. Ltd. and/or its authorised Service Providers to verify the above
information and/or contact you to assist you with the purchase and/or servicing.