Policy No : 16180462

Name : SHAMSHAD ALI

Address : VILL DAULATPUR
PO DAULATPUR
DIST BULANDSHAHR Policy / Application No. : B1316795
DAULATPUR
UTTAR PRADESH
202398
Application Inward Date : 22/01/2019
Customer Contact No. : 8016706731
Advisor Code : 20697437
Advisor Name : Fatima RAHMAN

Advisor Contact No. : 0/09859055174

SM Code : F45178

Subject: We have recieved your premium Ten Thousand

Dear SHAMSHAD ALI,

We hereby confirm the receipt of the premium payment towards your life insurance policy with us, through Cheque. We congratulate
you for ensuring your family's continued security and peace of mind.

Received Amount : ` 10,000.00

Amount in words : Rupees Ten Thousand Only.
Paid By : Cheque/DD/Credit Card No.: 889217 Date: 22-Jan-2019 Drawn on: STATE BANK
OF INDIA
Consolidated revenue stamp duty paid :

Terms and Conditions

1. You are eligible for income tax benefits under section 80C/80CCC(1)/80D and 10(10D), as applicable. Conditions apply.
2. Kindly consult a tax expert to understand income tax applicable on various financial aspects.
3. Service Tax / Goods & Services tax under relevant laws shall be charged.
4. This is system generated receipt, hence does not require signature.
5. Service Tax / Goods and Services Tax are levied at the applicable Tax rates in accordance with the prevailing Tax Laws, from
time to time.
6. For ULIP products, in respect of premium received up to 3 pm by the Company, the closing NAV of the business day on which
premium is received shall be applicable. In respect of premium received after 3 pm by the insurer the closing NAV of the next
business day shall be applicable.
7. Premium paid in advance will be applied to the policy on premium due date only.
8. Please note that with effect from 1 July 2017 (proposed date) or any other notified date, Goods & Services tax may be applicable
on the premium due / collected at the prescribed rates. The differential tax liability, if any, on account of Goods & Services tax
shall be borne by the policyholders and Company reserves the right to adjust / recover the same separately As per the
relevant terms and conditions stipulated in the policy document agreed with you.

Reliance Nippon Life Insurance Company Limited.(Reg. No. 121)

Corporate Office: 5th Floor, South Wing Reliance Centre, Off Western Express Highway, Santacruz East, Mumbai - 400 055.
Registered Office: 'H' Block, 1st Floor, Dhirubhai Ambani Knowledge City, Kopar Khairane, Navi Mumbai - 400710, Maharashtra, India
T +91 22 3303 1000 / F +91 22 3303 5662 | rnlife.customerservice@relianceada.com | www.reliancenipponlife.com
Call us : 1800 102 1010 (Toll Free) between 9am to 6pm(Monday to Saturday)
CIN: U66010MH2001PLC167089
Renewal premium receipt/Ver 1.0 /Nov2018 A Reliance Capital Company