Payment Receipt

Policy Number: 862906377 Date and Time: 31/05/2017 15:45 PM

Name: ANKITA SHUKLA Transaction No: IICI5400191968

Mobile Number: 9935292416

Dear ANKITA SHUKLA ,

Thank you for being part of the Max Life Insurance Family. This is to acknowledge the receipt of Rs 9222.21 ( Rupees Nine Thousand Two Hundred Twenty Two
and Twenty One paise only ) towards the payment reason - Renewal Premium for your insurance premium.

We value your patronage and are committed to providing you the best in class service.

Should you need any further assistance, please call our Customer Help Line - 1800 200 5577 (Toll free from any network). You can also email at
service.helpdesk@maxlifeinsurance.com.

Your Sincerely,
for Max Life Insurance Co. Ltd.

Authorized Signatory

Note:

● In case premium for Unit Linked Insurance policies is received in Max Life Insurance designated offices vide cash, local cheques & local demand drafts
before 3:00 PM, Net Asset Value (NAV) of the same day will be applicable; in case premium is received after 3:00 PM, the NAV of the next business
day will be applied. In case of premium received vide outstation cheques / demand drafts, the NAV of the business day on which such cheques /
demand drafts are realised & credited in Company's account will be applied.
● 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 mode.
● Monies received would be adjusted against the due premium as per the policy contract. In case policy status is lapsed, the risk coverage is subject to
the reinstatement of the policy as per terms and conditions of the plan opted.
● Final receipt would be sent to you after adjustment of monies as per the policy terms & conditions.
● Benefit under Section 80C / 80CCC / 80D of Income Tax Act, 1961 would be available as applicable. Service Tax which is applicable on the risk cover &
fund related charges under Section 65 (105) (zx) of Finance Act 1994, as amended by Finance (No.2) Act 2004 and Section 65 (105) (zzzzf) of Finance
Act 2008, is deducted from the funds at the applicable rates.

Max Life Insurance Co. Ltd. is a joint venture between Max Financial Services Limited and Mitsui Sumitomo Insurance Co. Ltd.
Registered Office: 419, Bhai Mohan Singh Nagar, Railmajra, Tehsil Balachaur, District Nawanshahr, Punjab -144 533. Corporate Office: Max Life Insurance Co. Ltd., 3rd, 11th and 12th Floor, DLF
Square Building, Jacaranda Marg, DLF City Phase II, Gurgaon (Haryana) - 122002. Operation Center: Max Life Insurance Co. Ltd, Plot No. 90-A Udyog Vihar, Sector 18, Gurgaon (Haryana) -
122015. Toll Free Helpline: 1800 200 5577. Online Term Plan Helpline: 1800 200 3383. Fax Number: 0124-4159397. Email Ids: service.helpdesk@maxlifeinsurance.com;
online@maxlifeinsurance.com. Insurance is the subject matter of solicitation.
Trade logos displayed belong to Max Financial Services Limited and Mitsui Sumitomo Insurance Co. Ltd. respectively and are used by Max Life Insurance Co.Ltd. under a license.
ARN: Max Life/Emailer/Indigo/January2016/163. Corporate Identity Number (CIN):U74899PB2000PLC045626. IRDAI - Registration No. 104.

MAX LIFE INSURANCE CO. LTD.

Operations Center, 90-A, Udyog Vihar, Sector 18, Gurgaon-122 015 Haryana
Service Tax Registration No. 443 / ST / DIV - III / GGN / 02