Commission Statement

1ST FN Sep 2013 - 1 Sep 2013 to 15 Sep 2013

Sec-I Agent Code Branch Code-Name Agent Name Address Line 1 Address Line 2 Address Line 3 City State Postal Code Contact Number Sec-III Base Commission 1000054742 1058-New Delhi 2 Rahul Pathak 32/1 A-1 Block Bangali Colony Sant Nagar Burari Delhi New Delhi Delhi (UT) 110084 9953911782 1058-Comm Statement - 1ST FN Sep 2013 1 0 0 Sec-II Bank Account Number (availability) No Pan Number (availability) Yes Agent Status for the cycle Active Payout on Hold Commission Payout Status## Bank Details not available

0 Transaction Date Policy Number Proposer Name 1 6-Sep-13 4000602874 Rajesh Jain 2 Gross Commission (A) 0 Release of hold payout (Cycle wise) (B) 1 2 2 Gross Total Commission (C)=(A)+(B) Sec-IV Gross Adjustments 0 Transaction Date Policy Number Proposer Name 1 2 Gross Adjustments (D) Sec-V Gross Total Commission (C)

Product Incomesurance Endowment & Money Back

Payment Mode Yearly

Commission Applied Commission Commission Type Premium Rate Amount Regular 11,640.00 30.00 3,492.00

3,492.00

3,492.00

Product

Payment Mode

Commission Applied Type Premium

Commission Commission Rate Amount

0.00 C 3,492.00

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Commission Statement
Gross Adjustments (D) Previous Recovery Adjustments (E) Other Adjustments (F) Total Payable Commission (before tax) (G) Taxes Service Tax (only for Brokers) (H) Income Tax (TDS) (I) Net Payable Commission (J) Profession Tax (only for Karnataka state agents) (K) Misc. Adjustments (if any, from 'Net Payable Commission') (L) Final Payable Amount (M) D E F G=C+D+E+F H I J=G+H-I K L M = J - (K + L) --- End of Statement --Glossary Sec-I Sec-II Sec-III A B C Sec-IV D Sec-V E F G H I J K L M
##

0.00 0.00 0.00 A 3,492.00 0.00 349.00 3,143.00 0.00 0.00 A 3,143.00

Contains Personal details of the Agent Provides status of Bank/PAN details availability with company, agent status and commission payout status for the cycle Provides policy level details of base commission for the cycle and details of earlier withheld payouts Total gross commission for the cycle Total commission payable for earlier withheld cycles Gross total commission payable (sum of A and B) Provides policy level details of commission adjustment - positive or negative - for the cycle Total commission recoverable/payable due to policy cancellations or self source policy adjustments Provides payable amount calculations Adjustments of pending recoverable of previous cycles Adjustments of recoverable/payable basis policy cancellation/mode change request from customer Total payable commission post adjustments Service Tax (if applicable) TDS as per prevailing rate Net payable commission after Taxes State professional tax (only for Karnataka) deductable from Net payable commission Adjustments of recoverable/payable from Net payable commission (if any) Final payable amount to be received by agent

Commission Payout Status Explanation Comments Explanation

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Commission Statement
Nil Payout Invalid PAN Recovery Non Renewal of IRDA License Terminated Agent Code Recovery Carry Forward No Payout Payout on Hold Bank Details not available Due to Agent Policy PAN not available

Recovery of additional TDS for earlier payouts, due to invalid PAN provided Commission withheld at gross level due to non renewal of license Commission withheld at gross level due to agent status 'terminated' as on payout date 'Total Payable Commission (before tax)' is negative, will be adjusted in future payouts Total payout adjusted against recovery for the cycle Payout on hold due to non availability of bank details Payout on hold due to agent itself is life assured Payout on hold due to non availability of valid PAN

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