STATEMENT OF COMMISSION

Commission generated as on 26 Jun 2021

Name : Manju, Devi Advisor Code : 01090824

Adress : PROFESSOR COLONY Manager Code : 00422661

VIDHYA MANDIR SCHOOL ROAD
NAUGACHIA Bank A/c No. : XXXXXXXXXX8553
BHAGALPUR Bank Name : STATE BANK OF INDIA,NAUGACHIA
Pincode : 853204 License No : ICI01090824 Expiry date : 31 December 2099

PAN No : AUWPD5250D

If any of the details above are incorrect or have changed, please inform us immediately through any of our service centres.

Customers can now pay their first premium deposit and renewal premium directly from their own bank branches using NEFT(RTGS)
money transfer facility. To know more details SMS ECOLLECT to 56767.

Summary of Commissions

Sr.No Particulars Amount (In ` )

A New business commission -50,750.00

B Renewal commission 62,087.32

C Amount equivalent to GST 11,175.72

D Group commission 0.00

E Adjustment where GST is applicable 0.00

F Rewards 0.00

G Adjustment where GST is not applicable 0.00

H Total commission & rewards for TDS (A + B + D + E + F + G) 11,337.32

I TDS 0.00

J Professional Tax 0.00

K Adjustment where GST & TDS is not applicable 0.00

L Final net commission & rewards (H-C+I+J+K) 161.60

Sr.No GST borne by the Company Amount (In` )

M GST on New Business (A*GST Rate) -9,135.00

N GST on Group Business (D*GST Rate) 0.00

O Adjustment where GST Applicable (E*GST Rate) 0.00

P GST on Rewards (F*GST Rate) 0.00

Total -9,135.00
RC
IC

Please provide your a/c mandate at the nearest ICICI Prudential branch to get remuneration on weekly basis.
Please note that the Company has duly paid GST under reverse charge on the above commission in accordance with the law.
ICICI Prudential Insurance Company Limited.
Communication Address: Unit No1A & 2A ,Raheja Tipco Plaza ,Rani Sati Marg,Malad(East), Mumbai-400 097
Page 1 of 3
Registered Office: 1089, Appasaheb Marathe Marg,Prabhadevi,Mumbai-400 025
 STATEMENT OF COMMISSION

Sum of New Business Commission and Productivity Linked Commission (Total: ` -50,750.00 )
Comm Policy Prod Premium Commission
Policy No Policy Holder Name Product Name Freq Term Transaction Details
Accural Date Issuance Date Code Amount Amount

19-February-2 19-February-20 GuaranteedSavingsIn New Business

17489760 . TRIPURARI KUMAR E05 01 20 25000.00 250
021 13 surancePlan Commission

30-Septembe 30-September- ICICI Pru Cash

81083790 KUMARI RITA E10 01 12P -100000.00 -30000 Policy Altered
r-2020 2020 Advantage

14-Septembe 14-September- ICICI Pru Cash

81083759 . TRIPURARI KUMAR E10 01 48P -100000.00 -21000 Policy Altered
r-2020 2020 Advantage

Renewal commission (Total: ` 62,087.32 )

Comm Policy Prod Premium Commission
Policy No Policy Holder Name Product Name Freq Term Transaction Details
Accural Date Issuance Date Code Amount Amount

YADAV NIRANJAN GuaranteedSavingsIn Renewal Premium

10-May-2021 10-May-2012 16642061 E05 02 20R 6000.00 300
PRASAD surancePlan Commission

24-February-2 24-February-20 ICICI Pru Cash

19158555 CHAUDHARY HARERAM E10 02 17C -200000.00 -10000 Contract Reversed
021 15 Advantage

24-February-2 24-February-20 ICICI Pru Cash Renewal Premium

19158555 CHAUDHARY HARERAM E10 02 17R 200000.00 10000
021 15 Advantage Commission

03-December- 03-December-2 ICICI Pru Cash Renewal Premium

19000011 JAISWAL ASHA E10 02 20R 64000.00 3200
2020 014 Advantage Commission

03-December-2 ICICI Pru Cash Renewal Premium

03-June-2021 19000011 JAISWAL ASHA E10 02 20R 64000.00 3200
014 Advantage Commission

24-February-2 24-February-20 ICICI Pru Cash Renewal Premium

19158555 CHAUDHARY HARERAM E10 02 17R 200000.00 10000
021 15 Advantage Commission

10-November- YADAV NIRANJAN GuaranteedSavingsIn Renewal Premium

10-May-2012 16642061 E05 02 20R 6000.00 300
2020 PRASAD surancePlan Commission

21-December- 21-December-2 ICICI Pru Cash Renewal Premium

20532531 JAISWAL RAMBHA E10 01 20R 50000.00 2500
2020 016 Advantage Commission

IPRU iCare II RP Renewal Premium

13-June-2021 13-June-2014 18664085 MADHUKAR RAJESH T41 01 20R 2475.00 123.75
Option II Commission

IPRU iCare II RP Renewal Premium

13-June-2021 13-June-2014 18664085 MADHUKAR RAJESH T41 01 20R 32274.00 1613.7
Option II Commission

07-January-20 07-January-201 Renewal Premium

18318474 JAISWAL ASHA E01 Save'n'Protect 01 13R 44304.00 2215.2
21 4 Commission

31-December- 31-December-2 ICICI Pru Savings Renewal Premium

18317983 KUMAR ABHINAV E12 01 15R 12000.00 600
2020 013 Suraksha-LP Commission

19-February-2 19-February-20 GuaranteedSavingsIn Renewal Premium

17489760 . TRIPURARI KUMAR E05 01 20R 25000.00 1250
021 13 surancePlan Commission

29-January-20 29-January-201 Renewal Premium

17399770 JAISWAL ASHA E01 Save'n'Protect 01 12R 24239.00 1211.95
21 3 Commission

06-March-202 ICICI Pru Renewal Premium

06-March-2020 67488871 RANI SWETA E26 01 67R 100000.00 4000
1 Lakshya-Lifelong Commission

30-January-20 30-January-202 ICICI Pru Renewal Premium

66206930 GARG ANSHRAJ E26 01 93R 50000.00 2000
21 0 Lakshya-Lifelong Commission

20-January-20 20-January-202 ICICI Pru Renewal Premium

64722300 YADAV VINAY KUMAR E25 01 20R 50000.00 2000
21 0 Lakshya-Wealth Commission

31-December- 31-December-2 ICICI Pru Future Renewal Premium

63053663 THAKUR MITHLESH E21 01 15R 16411.00 820.55
2020 019 Perfect Commission

Renewal Premium
19-June-2021 19-June-2019 41900853 SHARAN PREM SHILA UB6 Life Time Classic 01 10R 50000.00 1000
Commission

16-December- 16-December-2 Renewal Premium

30411077 KUMAR ASHU UB6 Life Time Classic 01 10R 60000.00 1200
2020 018 Commission

06-November- 06-November-2 ICICI Pru iProtect Renewal Premium

28726108 KUMAR RAHUL T51 01 40R 2500.00 187.5
2020 018 Smart Commission

06-November- 06-November-2 ICICI Pru iProtect Renewal Premium

28726108 KUMAR RAHUL T51 01 40R 14711.00 1103.32
2020 018 Smart Commission

28-February-2 28-February-20 ICICI Pru Savings Renewal Premium

21945983 MANJEET MR E12 01 20R 50000.00 2500
021 18 Suraksha-LP Commission

04-March-202 ICICI Pru iProtect Renewal Premium

04-March-2018 21945980 MANJEET MR T51 01 41R 500.00 25
1 Smart Commission

21-December- 21-December-2 GuaranteedSavingsIn Renewal Premium

16224722 .. PUSHKAR E05 01 20R 12000.00 600
2020 011 surancePlan Commission

16-March-202 ICICI Pru Savings Renewal Premium

16-March-2017 20688287 SANJAY KUMAR E12 01 15R 96386.00 4819.3
1 Suraksha-LP Commission

Please provide your a/c mandate at the nearest ICICI Prudential branch to get remuneration on weekly basis.
Please note that the Company has duly paid GST under reverse charge on the above commission in accordance with the law.
ICICI Prudential Insurance Company Limited.
Communication Address: Unit No1A & 2A ,Raheja Tipco Plaza ,Rani Sati Marg,Malad(East), Mumbai-400 097
Page 2 of 3
Registered Office: 1089, Appasaheb Marathe Marg,Prabhadevi,Mumbai-400 025
 STATEMENT OF COMMISSION

Renewal commission (Total: ` 62,087.32 )

Comm Policy Prod Premium Commission
Policy No Policy Holder Name Product Name Freq Term Transaction Details
Accural Date Issuance Date Code Amount Amount

IPRU Wealth Builder Renewal Premium

27-May-2021 27-May-2017 21036921 RANI PREMA UA6 01 10R 100000.00 2000
II Commission

06-November- 06-November-2 ICICI Pru Future Renewal Premium

21560012 GUPTA SUSHIL E21 01 15R 25830.00 1291.5
2020 017 Perfect Commission

05-December- 05-December-2 CHOUDHARY SURENDRA ICICI Pru Cash Renewal Premium

21653295 E10 01 20R 100000.00 5000
2020 017 KUMAR Advantage Commission

27-December- 27-December-2 Renewal Premium

21740844 KUMAR AKHILESH UB6 Life Time Classic 01 10R 100000.00 2000
2020 017 Commission

21-December- 21-December-2 GuaranteedSavingsIn Renewal Premium

16223882 KUMAR BINOD E05 01 20R 12000.00 600
2020 011 surancePlan Commission

04-March-202 ICICI Pru iProtect Renewal Premium

04-March-2018 21945980 MANJEET MR T51 01 41R 8511.00 425.55
1 Smart Commission

10-January-20 10-January-201 SINGH SOMNATH Renewal Premium

21808366 UB2 Elite Life Super 01 10R 200000.00 4000
21 8 KUMAR Commission

Please provide your a/c mandate at the nearest ICICI Prudential branch to get remuneration on weekly basis.
Please note that the Company has duly paid GST under reverse charge on the above commission in accordance with the law.
ICICI Prudential Insurance Company Limited.
Communication Address: Unit No1A & 2A ,Raheja Tipco Plaza ,Rani Sati Marg,Malad(East), Mumbai-400 097
Page 3 of 3
Registered Office: 1089, Appasaheb Marathe Marg,Prabhadevi,Mumbai-400 025