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Premium Certificate

For the purpose of deduction under section 80D of Income Tax


amendment
act, 1961 and any amendments made thereafter.

DEEPAK KAMBLE
B 501, 5th Floor, Salasar Aangan Building, Beverly Park. Near Galaxy Hospital, Mira Road (East) Near, Cinemax , Kanakia
Road, , Jnpt 401107 Thane - Maharashtra, , Jnpt 401107 Thane - Maharashtra

THANE
MAHARASHTRA
401107

This is to certify that the company has received the premium of Rs.29,995 for Health insurance coverage under the policy no.
4128i/iHR/W- 35785980/01/000 vide Credit Card dated 12-May-2018.

The product is eligible for deduction u/s 80D of the Income Tax Act, 1961 and any amendments made there to.

For ICICI Lombard General Insurance Company, IRDA Regn No. 115

Authorized Signatory

Note:

+ This certificate must be surrendered to the Insurance Company in case of Cancellation of the policy. In the event of
incorrect representation of this declaration, the liability shall be upon the policyholder.
» For the purpose of deduction under section SUIT, the benefit shall be as per the provisions of the Income Tax Act, 1961
and
Any amendments made thereafter.

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