Date: 25/11/2019

Mr. Rahul Kandiyal

PREMIUM PAID CERTIFICATE FOR THE YEAR 2019-2020

This is to certify that as per our records the following payments have been received by us to effect or
keep "In Force" Life Insurance Policies held by
Mr. Rahul Kandiyal

Life Assured's Name: Rahul, Kandiyal

Policy No.: 13149867 Plan Name: ICICI Pru LifeTime Maxima

Benefits/Rider Sum Assured Coverage Premium Amount Premium Due UIN

ICICI Pru LifeTime Maxima 250,000.00 SEC 80 C 22,530.00 0.00 105L096V01
Accdntl Death&Disability Ride 250,000.00 320.00 0.00 105L096V01
Policy Total 22,850.00
Premium Paid in 0.00
Advance
Total Premium 22,850.00
Premium Paid 22,850.00

Premium Paid to avail Income Tax Benefits Under:

SEC 80 CCC(1) 0.00

SEC 80 C 22,530.00
SEC 80 D 320.00
0.00

Total 22,850.00

Please note the mortality charges under the base plan as well as riders (if any) would be recovered every
month as per the Terms and Conditions of the Policy.

The above mortality charges are the actual charges recovered till date. The recovery of such charges would
be subject to change on monthly basis.

This is a computer generated statement and does not require any signature.

ICICI Prudential Life Insurance Company Limited.

Communication Address:Vinod Silk Mills Compound,Chakravarthy Ashok Road, Ashok Nagar,Kandivali(E), Mumbai-400 101
Registered Office:ICICI Prulife Towers,1089, Appasaheb Marathe Marg,Prabhadevi,Mumbai-400 025
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