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17-Dec-2013

Premium Certificate Financial Year 2012 - 2013 To whomsoever it may concern Azeezulla Shaik
IP 16 Erramanzil Colony Near Ravindra Niketan School Hyderabad Andhra Pradesh Pin: Phone: Client ID: 500082 9948800936 9951222786 54558014
Serial No. 0231954617122013

This is to confirm that we have received premium(s) from the above named Policy holder under the Policy No (s) as per details given below Policy No: Plan Component
Accidental Death Benefit Rider (UIN-107C001V01) Kotak Capital Multiplier Plan (UIN-107N011V01)

02319546 Premium(A)
80.00 15,120.00

S.Tax(B)* Ed Cess(C)*
10.00 227.00 0.00 7.00

Total
90.00 15,354.00

* In addition to the amount under (B) and (C), Service Tax and Education Cess computed on applicable charges recovered from the Accumulation account / value of units is Rs. The total Service Tax and Education cess collected is Rs. 244.00 Premiums are eligible for tax deduction under Section 80C/80CCC of Income Tax Act,1961. Tax laws are subject to change from time to time. Please consult your tax advisor for implications.
Notes: 1 Service Tax, Education Cess and Higher Secondary Education Cess on Service Tax, is levied at the applicable Tax rates in accordance with the prevailing Tax Laws, from time to time. 2 3 Service Tax Registration Number: AAACO3983BST002. Service Tax Classification: Insurance Auxiliary Service, life insurance services and Management of investment under ULIP services.

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17-Dec-2013 Thanking you, Yours sincerely, For Kotak Mahindra Old Mutual Life Insurance Ltd.

Authorised Signatory