Agent Activity Report

for the commission cycle ending December 31, 2011

Agent Name Agent Number PAN Phone Email
mukeshsingh.rajak@gmail.com MUKESH RAJAK 016225-04-126631 ATHPR8004P

MOA Name MOA Code Branch Title Contract Date

Indore - City Centre (AG) AGENT September 13, 2011

Summary of earnings for the commission cycle ending December 31, 2011
Earnings
New Business commission (A) Renewal commission (B) Previously withheld release Quarterly Vested Bonus (E)

Rs
0.00 0.00 0.00 0.00

Deductions
Previous Adjustments (C) Policy Cancellation (D) Income Tax Shortages Service Tax Plus Education Cess on Second year Renewal Cheque Dishonour Penalty Charges

Rs
0.00 0.00 0.00 0.00 0.00 0.00 0.00

Gross Earning

0.00

Net Earning

New Business Commission for the period December 17, 2011 - December 31, 2011
Policy No. Policy holder name Product Premium Commission Issuance Date Next Renewal Due Date

Total New Business Commission earned

Renewal Commission for the period December 17, 2011 - December 31, 2011
Policy Policy holder name Product Premium Commission Issuance Date Next Renewal Due Date

Total Renewal Commission earned

Policy Cancellations / Reversals for the period December 17, 2011 - December 31, 2011
Policy No. Policyholder's Name Product Premium Commission Deduction Reason Cancellation Date

Total commission deductions due to cancellation

Commission Due for polices under free look period

Policy No. Policy holder's name Product Premium Commission Issuance Date Freelook Period Cycle Date

Total commission

Potential Renewal Commission Earnings for the period December 31, 2011 - March 31, 2012
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Policy No.

Policy holder's name

Product

Premium

Commission

Issuance Date

Renewal Due Date

Total Renewal commission earn

New Business Commission

160,000

130,000

Commission earned in Rs.

100,000

70,000

40,000

10,000

1,213

-20,000

-50,000 January'11 March'11 May'11 July'11 September'11 January'11 February'11 April'11 June'11 August'11 December'11 February'11

Persistency for last 12 months

Dec2010 0.00 Jan2011 0.00 Feb2011 0.00 Mar2011 0.00 Apr2011 0.00 May2011 0.00 Jun2011 0.00 Jul2011 0.00 Aug2011 0.00 Sep2011 100.00 Oct2011 100.00 Nov2011 100.00

How to read your commission statement

Summary of earnings for the commission cycle gives an overview of the commission earned for the last commission cycle, bonus, if any and applicable deductions like policy cancellations, income tax etc. from the total earnings. Previous adjustments are the negative earnings carried forward from the previous commission cycle. Income tax is deducted at the rate of 10% in case of advisors PAN is available and at the rate of 20% in case the PAN is not available. Thus it is in your best to get your PAN details updated, in case you have not done so already. Policy cancellations details polices which have applied and thus the commission credited previously has to be reversed and is thus deducted Commission Due for policies under Free look Period lists policies which are under the freelook period, and commission for these polices will be due in the future commission cycles as mentioned. Quarterly Vested Bonus (QVB) is the bonus paid on the net quarterly policies issued and calculated as a percentage of your commission ea

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Important Note:
In line with the IRDA guideline, we are required to inform customers about their rights in terms of the prescribed time frames for issuance, servicing and claims processing. The prescribed timelines are mentioned below for your reference. Kindly inform all your customers about the same.

Policy Holder Servicing Turnaround Times As Prescribed By IRDA for Life Insurance Companies Service Maximum Turn Around Time
15 days 30 days

General Processing of Proposal and communication of decision including requirements/issue of policy/cancellation Obtaining copy of the Proposal Post Policy issue services request concerning mistake/refund of proposal deposit and also Non-Claim related services requests Life Insurance Surrender value/annuity/pension processing Maturity claim/Survival benefit/penal interest not paid Raising claim requirements after lodging the Claims Death claim settlement without investigation requirement Death claim settlement/repudiation with Investigation requirement Grievances Acknowledge a grievance Resolve a grievance 3 days 15 days 10 days 15 days 15 days 30 days 6 months

10 days

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