Premium Certificate

For the purpose of deduction under section 80D of Income Tax Act, 1961 and any amendments made thereafter*.

This is to certify that MR. RAJESH ADLURI has paid the premium of

₹20,082.72 (in words) Twenty Thousand Eighty Two and Seventy Two paise only for the period 06/01/2020

to 05/01/2021 towards Premium for Health Insurance policy for term of One Year policy.

Policy
Number PROHLT155005754

Receipt Receipt Payment

R001111840 Date 06/01/2020 163.00 HRP
Number Amount Mode

Receipt Receipt Payment

R001111842 Date 06/01/2020 19,919.72 CREDITCARD
Number Amount Mode

* Note:
1. For your eligibility and deductions please refer to provisions of Income Tax Act, 1961 as modified and/or consult your tax
consultant.
2. Any amount paid in cash towards premium will not qualify for tax benefits.
3. In case of dishonour of premium instrument, the policy will be deemed cancelled ab initio.
4. Deduction under section 80D shall not be allowed if the premium is paid by third party (other than proposed/insured) under
this policy.
5. This certificate must be surrendered to us in case of cancellation of Policy or for issuance of fresh certificate in case of any
alteration in the insurance affecting the premium.

Yours Sincerely,
ManipalCigna Health Insurance Company Limited

(Formerly known as CignaTTK Health Insurance Company Limited)

‘This is a system generated communication and does not require signature’.

Date: 06/01/2020
Location: Mumbai
ManipalCigna ProHealth Insurance_Policy Schedule [CTTHLIP18045V031819] PROHLT155005754