Dear PATEL PRASHANTKUMAR SITARAMBHAI

Thank you for choosing Birla Sun Life Insurance as your preferred insurance partner for securing your familys future.
Amount of Rs. 6,009.06 has been received. The details are as follows:
PATEL PRASHANTKUMAR SITARAMBHAI
38 Vaijnathparu Baharmadh
Near Rangpur Vaadi
Unjha
MAHESANA - 384170

RENEWAL PREMIUM

Rs. 6,009.06

Total Amount
Rs. 6,009.06
Amount in Words : Rupees Six Thousand Nine And Paise Six only

Receipt No: 100482850

Payment Received from : PATEL PRASHANTKUMAR SITARAMBHAI
Owner Name : PATEL PRASHANTKUMAR SITARAMBHAI

Policy/Premium Paying Term: Regular Premium

Modal Premium and Mode: Rs. 6009.55, Annual

Policy Number: 003563781
Plan Name: BSLI Dream Plan - 100%
Payment : Net Banking
Remark :
Requirements for Revival if any :

Insurance Advisor: AU7908 Patel Prashantkumar Sitarambhai

Date: 02/11/2015 18:30
Branch Name and Address:G - CORP TECH PARK,5TH FLOOR KASAR
VADAVALI,GHODBUNDER ROAD,THANE WEST 400 601 TEL 3996
1000

Signature Not Verified

Digitally signed by DS BIRLA SUNLIFE INSURANCE
COMPANY LTD (1)
Date: 2015.11.02 18:30:10 IST
Reason: I am authorizing this receipt.
Location: BSLI, MUMBAI

Consolidated revenue stamp duty has been paid by demand draft vide receipt number MH000401003201516E dated 21/04/2015.

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