Premium Paid Certificate

MR. G.Srinivasaperumal,
No 22 Rivera Enclave,
Pandian Street, Devaraj Nagar,
Anakaputhur, Chennai – 600070
Tamilnadu, India

Dear Valued Customer,

Greetings from Exide Life Insurance!

This is to certify that Mr. G.Srinivasaperumal has paid Rs.24,561/- (Total Premium In Words : Indian Rupees twenty four
Thousand five Hundred sixty one Only ) the following renewal premium payments have been made towards your Premium for
Hospitalization Insurance vide Policy No: 02865559 - Exide Life Insurance Policies for the financial year 2018-2019.

Payment received by Cheque/Credit/Debit Card vides collection No: 10048963 / 24-Feb-2019

Policy Policy Regular Top up GST Premium

Number Commencement Premium Premium (in INR)* Paid
Date (in INR) (in INR) (in INR)
02865559 24/02/2014 20140.02 - 4420.98 24.561.00
Total 24,561.00

Please get in touch with us for any further assistance.

We hope to serve you again.

Yours sincerely,

Customer Services
Exide Life Insurance Company Limited
(Formerly ING Vysya Life Insurance Company Limited)

This is a system-generated letter, hence requires no signature.

Insuranceisthesubjectmatterofthesolicitation.Premiumpaidinadvancewouldbeheldindepositwithoutinterest,thepremiumwillbeadjustedtothepol
icyontheduedate.Taxbenefitsoninsurancepremiumareasperprevailingincometaxlawsandaresubjecttoamendments made thereto from time
to time.

*ServiceTax,Educationcessoranyotherformoftaxesorchargesorlevieswillbeadditionallychargedasperprevailinglawsandregulationswherever
applicable.ForUnitLinkedPoliciesservicetaxandeducationcesswillbedeductedthroughcancellationofunitsasper prevailing laws and
regulations.

Ifthepaymenthasbeenmadebycheques,ECS,StandingInstructions,thecontinuationofcoverunderthispolicyandthevalidityofthisreceipt is subject
to realization of the payment.

As per Government of India directive, if you are holding single or multiple policies where your aggregate premium payment for
thefinancialyearisRs.50,000orabove,pleasesubmitPANcardorform60/form61asapplicable.Pleaseignoreifyouhavealreadysubmittedthedocum
ents.