STATEMENT OF PREMIUMS PAID FOR THE PERIOD 01-APR-18 to 18-MAR-19

Client Number: 5011434548 Date of Issue: 24-MAR-19

Name: MR.DEEPAK K SAHOO Your PAN No: CMQPS8166P
Address: PLOT NO 61 2ND DOOR, 2ND FLOOR
SAI BABA ROAD, MINEKOLALA
LAKSHMI BAIBHAV RESTURANT
Bengaluru - 560037
Telephone: 9836940040
Mail Id: DEEPAKSAHOO2010@GMAIL.COM

Policy No. Plan Premium PAID#* Premium Payment Effective Date of

(Rs) Frequency Coverage
545153330 Max Life Online Term Plan Plus CO New 6,775.56 Semi-annual 17-DEC-18
Total 6,775.56

INTEREST ON LATE PAYMENT (only in case of non-linked plans) : 0.00

Note: || # The Premiums mentioned in this document are subject to realization of the cheques/instruments/monies. || *The total premium amount is inclusive
of IGST/CGST/SGST as may be applicable. || This statement summarizes premiums paid by you in the specified period and is being used in addition to the
receipts which we have already issued and sent to you on your payment of premiums || Above premiums may be eligible for tax benefit under Section 80C
/ 80CCC / 80D of Income Tax Act 1961.Tax benefits as mentioned in the policy are subject to prevailing tax laws, which are subject to change. You are
advised to seek the opinion of your tax advisor in relation to applicable tax benefits and liabilities.
To serve you better request you to please update your Email id and latest contact number by calling us at our toll free number:
18601205577 or through any of our branches.

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