Dear ASHISH KUMAR DUBEY

Thank you for choosing Birla Sun Life Insurance as your preferred insurance partner for securing your family’s future.
Amount of Rs. 17,798.66 has been received. The details are as follows:
ASHISH KUMAR DUBEY RENEWAL PREMIUM Rs. 17,407.02
ASHISH KUMAR DUBEY
B-460 NH2 NTPC
VINDHYANAGAR NTPC
COLONY VINSHYANAGAR
SINGRAULI - 486885 CGST(9.00%) Rs. 195.82
SGST(9.00%) Rs. 195.82
Total Amount Rs. 17,798.66
Amount in Words : Rupees Seventeen Thousand Seven Hundred
Ninety Eight And Paise Sixty Six only

Receipt No: 100947753

Payment Received from : ASHISH KUMAR DUBEY SAC Code:00440186
Owner Name : ASHISH KUMAR DUBEY SAC Desc:Life Insurance
Modal Premium and Mode: Rs. 17798.66, Annual
Policy Number: 006828669 Supplier GSTIN:27AABCB4623J1ZS
Plan Name: NA Policy/Premium Paying Term: 12 Years
Payment : Net Banking
Remark :
Requirements for Revival if any :
Next Due Date : 10/08/2018

Insurance Advisor: BO3763 Tripathi Sandhya

Date: 11/08/2017 22:15 Signature Not Verified
Branch Name and Address:G - CORP TECH PARK,5TH FLOOR KASAR Digitally signed by DS BIRLA SUN LIFE INSURANCE
COMPANY LIMITED 1
VADAVALI,GHODBUNDER ROAD,THANE WEST 400 601 TEL 3996 Date: 2017.08.11 22:15:07 IST
Reason: I am authorizing this receipt.
1000 Location: BSLI, MUMBAI

Consolidated revenue stamp duty has been paid by demand draft vide receipt number MH008566924201617E dated 16/02/2017.
1/1