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Date: 22/2/2013 Mr.

Navdeep Kaushal

PREMIUM PAID CERTIFICATE FOR THE YEAR 2012-2013


This is to certify that as per our records the following payments have been received by us to effect or keep "In Force" Life Insurance Policies held by Mr. Navdeep Kaushal Life Assured's Name: Navdeep, Kaushal Policy No.: 13149867 Benefits/Rider ICICI Pru LifeTime Maxima Accdntl Death&Disability Ride Sum Assured 250,000.00 250,000.00

Plan Name:ICICI Pru LifeTime Maxima Coverage SEC 80 C Premium Amount 21,791.00 209.00 Premium Due 0.00 0.00 Policy Total Premium Paid in Advance Total Premium Premium Due UIN 105L096V01 105L096V01 22,000.00 0.00

22,000.00 2,000.00

Premium Paid to avail Income Tax Benefits Under:

SEC 80 CCC(1) SEC 80 C SEC 80 D

0.00 22,000.00 0.00 0.00 Total 22,000.00

Please note the mortality charges under the base plan as well as riders (if any) would be recovered every month as per the Terms and Conditions of the Policy. The above mortality charges are the actual charges recovered till date. The recovery of such charges would be subject to change on monthly basis. This is a computer generated statement and does not require any signature.

ICICI Prudential Life Insurance Company Limited. Communication Address:Vinod Silk Mills Compound,Chakravarthy Ashok Road, Ashok Nagar,Kandivali(E), Mumbai-400 101 Registered Office:ICICI Prulife Towers,1089, Appasaheb Marathe Marg,Prabhadevi,Mumbai-400 025 Page 1