Bajaj Allianz Life Insurance Co. Ltd.

Certificate For Premium Paid

(01-Apr-2011 to 31-Mar-2012)

Date: 24/07/2012

This is to certify that the premium under the following policies taken by the policy holder MRS LAKSHMI .I has been received by Bajaj Allianz Life Insurance Company Limited during the financial year 2011-2012. Policy No Product Premium Due Date 28/04/11 28/10/11 Premium Adjustment Date 21/06/11 12/11/11 Premium Type Renewal Premium Renewal Premium Sum Assured 100000 100000 Total : Premium Amount Received 5000 5000 10000.0 Life Insurance Premium(1) 5000 5000 10000.0 Health Care Premium(2) 0 0 0.0 Service Tax Including Edu.cess 0 0 0.0

0125791796 FAMILY_AS SURE FAMILY_AS 0125791796 SURE

Note:
Receipts issued subject to realization of cheques. (1) Life Insurance Premium is eligible for tax rebate/deduction under Section 80C. (2) HCB/C1/Post Hospitalization/Surgical Benefit Rider Premium is eligible for tax rebate/deduction under Section 80D.. * Single Premium Policies with cover less than 5 times the premium paid will not be eligible for tax deduction under section 80C. This certificate is issued for the purpose of claiming deductions, rebates as per the provisions of Income Tax Act, 1961. For your actual eligibility please refer to provisions of IT Act 1961 as modified and consult your tax consultant.

Note: This is a computer-generated letter and does not required a signature.