Version:1.

3_(24/08/10)

sandy5herga@gmail.com
Maharashtra 400072 Naka,
Maharashtra400072Mumbai
05 Nov 2010
RENEWAL PREMIUM RECEIPT Ninty
A-Win G, Disouza Feet
Nagar Road
Saki

Life Assured: Mr. Firoz Jigar Wadhwani

Proposer: Mr. Firoz Jigar Wadhwani
B-2 Flat No.313 Maniar Apt Avail of potentially higher return over
Dindayal Nagar long term with flexible investment option.
Vasai (W) Presenting LifeTime Maxima from ICICI Prudential.
Thane For more information, SMS 'LIFE' to 57827.
Maharashtra
401202 Date of Receipt Policy Status UIN *
Tel.No. :- 9833420569 In Force
04/01/2012 105L017V01
Cheque Number Cheque Date Receipt Number Name of Bank
81466171
Policy Number Plan Name
05254687 LifeTime Super Pension
Due Date
Benefits Amount
From To
06/10/2011 05/04/2012 LifeTime Super Pension 24000.00

Total 24000.00

Tax benefits would be available as follows: Life Insurance Policy u/s 80c, *Interest on late payment will be charged
Pension Policy u/s 80CCC, Health Riders (if any) u/s 80D. Tax benefits @ 0.00 p.a. compounded half-yearly
would be as per prevailing Income Tax laws. Service Tax and Education
Cess extra as applicable. Servce Tax Details: Category of Service: Life Your next due date is : 05/04/2012
Insurance Service. Registration NO: MIV/ST/IAS-LIFE/1;
PAN BASED STC NO:AAACI7351PST001 Balance in Deposit 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