Version:1.

3_(24/08/10)

sandy5herga@gmail.com

RENEWAL PREMIUM RECEIPT

Life Assured: Mr. Firoz Jigar Wadhwani Proposer: Mr. Firoz Jigar Wadhwani B-2 Flat No.313 Maniar Apt Dindayal Nagar Vasai (W) Thane Maharashtra 401202 Tel.No. :9833420569

Maharashtra 400072 Naka, Maharashtra400072Mumbai 05 Nov 2010 Ninty Feet Road A-Win G, Disouza Nagar Saki

Avail of potentially higher return over long term with flexible investment option. Presenting LifeTime Maxima from ICICI Prudential. For more information, SMS 'LIFE' to 57827.

Date of Receipt 04/01/2012 Receipt Number 81466171

Policy Status In Force Name of Bank

UIN * 105L017V01

Cheque Number Policy Number 05254687 Due Date From

06/10/2011

Cheque Date

Plan Name LifeTime Super Pension To Benefits

LifeTime Super Pension

Amount
24000.00

05/04/2012

Total
Tax benefits would be available as follows: Life Insurance Policy u/s 80c, Pension Policy u/s 80CCC, Health Riders (if any) u/s 80D. Tax benefits would be as per prevailing Income Tax laws. Service Tax and Education Cess extra as applicable. Servce Tax Details: Category of Service: Life Insurance Service. Registration NO: MIV/ST/IAS-LIFE/1; PAN BASED STC NO:AAACI7351PST001

24000.00

*Interest on late payment will be charged @ 0.00 p.a. compounded half-yearly Your next due date is : Balance in Deposit
05/04/2012 0.00

Mudrank No.: CONSOLIDATED REVENUE STAMP DUTY PAID : NOTIFICATION NO - MUDRANK 0715/21451/CR-322/M1-23/08/2010 * UIN - Unique Identification No. Specified by IRDA. If the payment has been made other than in cash, this receipt is conditional upon the credit in company's account post clearance of the instrument/facility including electronic modes. This is a computer generated advice and does not require any signature.

Going Green - Committed to saving paper for a greener future: Effective Aug '09, customers on monthly premium paying frequency will receive their printed receipts on a quarterly basis. The monthly receipts will be emailed to the registered email id and will also be available on www.iciciprulife.com

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