Airport Road Yerwada, Pune-411006 0548336420 RENEWAL PREMIUM RECEIPT Policy Number : 0294648294 Policy Holder Name : MR JAYANTA MAITY Address : C/O -SOIBAL CHATTERJEE HARHPO+PS-~GHATAL VILL-KUSHPATA WEST MIDNAPORE WEST BENGAL 721212 Receipt No. 0548336420 Payment Date 26-FEB-2014 Received with thanks from MR JAYANTA MAITY Gross Amount (in Rs.) 25000 Amount in Rs.(in Words) Twenty Five Thousand Only Mode of payment Online Net Banking(Trans ID-MHDF3267601588) Premium Amount Rs. 25000 Product Name LIFE_ASSURE_PLAN_MORE Name of Life Assured MR JAYANTA MAITY Date Of Commencement 11/02/2013 Deposit B/F N/A Service Tax 0.0 Date Of Maturity 11/02/2023 Deposit C/F N/A Education Cess 0.0 Mode Annual X Change B/F 0.0 Higher Edu. Cess 0.0 Late Fees STM CODE 1100075947 I.C Code 1002298772 NEXT PREMIUM DUE DATE 10-FEB-2015 MUDRANK No. 1500/299 Dated 18/06/2013 Utilization shall be done as per applicable IRDA Guideliness in this regards Advance premium collected shall be utilized on premium due date.Amount held in deposit will not attract any interest.For eligibility under applicable sections of Income Tax Act 1961. Please refer relavant provisions and rules. Visit our website: www.bajajallianzlife.co.in BSNL: 1800 233 5858, Tata: 1800 209 7272 Email Us: renewalvertical@bajajallianzlife.co.in or life@bajajallianzlife.co.in Bharti: 1800 103 7272, Reliance: 1800 3000 7272 Customer Copy