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Bajaj Allianz Life Insurance Company Limited GE Plaza, Ground Floor Airport Road Yerwada, Pune-411006

0400901225

RENEWAL PREMIUM RECEIPT Policy Number : 0130204572 Policy Holder Name : MR SATPUTE MATHURADAS NAVANATH .

Address : AT CHINCHAPUR , POST ,~ASHTA HARINARAYAN TQ - ASHTI BEED MAHARASHTRA 414203

Receipt No. Received with thanks from Gross Amount (in Rs.) Amount in Rs.(in Words) Mode of payment Premium Amount Rs. Product Name Name of Life Assured Date Of Commencement Date Of Maturity Mode Late Fees STM CODE 2520000129 15/07/2009 15/07/2029 Annual

0400901225

Payment Date

22/7/2011

MR SATPUTE MATHURADAS NAVANATH . 12500 Twelve Thousand Five Hundred Only Online Net Banking(Trans ID-MSBI1078053924) 12500 NEW UNITGAIN MR SATPUTE MATHURADAS NAVANATH . Deposit B/F Deposit C/F X Change B/F N/A N/A 0.0 Service Tax Education Cess Higher Edu. Cess 0.0 0.0 0.0

I.C Code

2000000090

NEXT PREMIUM DUE DATE

15-JUL-2012

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: Email Us:

www.bajajallianzlife.co.in renewalvertical@bajajallianzlife.co.in or life@bajajallianzlife.co.in

BSNL: Bharti:

1800 233 5858, 1800 103 7272,

Tata:

1800 209 7272

Reliance: 1800 3000 7272

Customer Copy