STATEMENT OF COMMISSION

Commission generated as on 21 Apr 2018

Name : ANUPA, RATHORE Advisor Code : 01343744

Address : 122 near rajasthan bank Manager Code : 01340885

0
Bank A/c No. : 685401500442
BARAN
BARAN Bank Name : ICICI Bank Ltd,Antah Baran Br

License No : ICI01343744 Expiry date : 08 Apr 2023

Pincode : 325202
PAN No : BKBPR2241A

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

S No. Particulars Amount

A New Business Commission 7,500.00

B GST(A*GST Rate) 1,350.00
C Renewal Commission 0.00
D GST(C*GST Rate) 0.00
E Group Commission 0.00
F GST(E*GST Rate) 0.00
G Adjustment where GST Applicable 0.00
H GST(G*GST Rate) 0.00
I Rewards 0.00
J GST (I * GST Rate) 0.00
K Adjustment where GST not Applicable 0.00
L GST(No GST Applicable) 0.00
M Total Commission & rewards for TDS (A + C + E + G + I +K) 7,500.00
N Total Commission & rewards Net of GST recovery (M -D) 7,500.00
O TDS 0.00
P Professial Tax 0.00

Q Commission & rewards Net of Taxes (N+O+P) 7,500.00

R Adjustment where GST & TDS not Applicable 0.00

S Final net Commission & rewards (Q+R) 7,500.00

T Total Commission & rewards for GST (A + C + E + G + I) 7,500.00

U Total GST (B + D + F + H + J) 1,350.00

Sum of New Business Commission and Productivity Linked Commission(Total: Rs 7,500.00 )

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

09/03/18 09/03/18 22045426 RATHOR NAVEEN UB6 Life Time Classic 01 15N 125000.00 7500.00 New Business Commission

Please provide your a/c mandate at the nearest ICICI Prudential branch to get commission on weekly basis.
ICICI Prudential 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
Page 1 of 2
 Product Name UIN Product Name UIN Product Name UIN Product Name UIN
ICICIPru Forever life 105N001V01 ICICIPru Forever Life 105N001V02 ICICIPru Forever Life 105N002V01 ICICIPru Single Premium 105N003V01
-Regular Premium -Regular Premium -Single Premium Deferred Bond - Single Premium
Deferred Pension Pension Endowment Bond with
Guaranteed Additions

Save "n' Protect 105N004V01 Save "n' Protect 105N004V02 ICICIPru Cashbak 105N005V01 ICICIPru Cashbak 105N005V02
-Anticipated Endowment
Assurance with Deferred
Participation in profits

ICICIPru Life Guard ICICIPru Life Guard ICICIPru Life Guard CICIPru Life Guard -Single
-Level Term Assurance 105N006V01 -Level Term Assurance 105N006V02 105N007V01 Premium Level Term 105N007V02
-Single Premium Level
with Return of premiums with Return of Premiums Term Assurance Assurance

ICICI Pru Salaam 105N008V01 ICICI Pru Immediate 105N009V02 ICICI Pru Immediate 105N009V03 ICICI Pru Immediate 105N009V04
Zindagi Annuity Annuity Annuity

ICICIPru-ReAssure 105N010V01 CICIPRu-Assure Invest 105N011V01 ICICIPRu-Assure Invest 105N011V02 ICICI Pru Life Link 105L012V01

ICICI-Pru Smart Kid 105N014V02 ICICI-Pru Life Time 105L015V01 CICI-Pru Life Link 105L016V01 LifeGuard Level Term 105N017V01
Pension Pension Assurance

LifeGuard Level Term 105N017V02 Easy Life 105N018V01 ICICI Pru Group Term 105N019V01 ICICI Pru Group Term 105N019V02
Assurance Insurance Insurance

ICICI Pru Suraksha - 105N021V01 ICICIPru Mitr - Regular 105N022V01 ICICI Pru Group Gratuity 105L023V01 ICICI Pru Group Gratuity 105L023V02
Regular Premium Premium Without Profit
Endowment Plan

ICICI Pru Group 105L024V01 ICICI Pru Group 105L024V02 ICICI Pru Secure Plus 105L025V01 ICICI Pru Cash Plus 105L026V01
Superannuation Plan Superannuation

ICICI Pru Smart Kid - 105L028V01 ICICI Pru Smart Kid - Unit 105L029V01 ICICI Pru Group Term 105N030V01 ICICI Pru LifeTime II 105L031V01
Unit Linked(RP) Linked(SP) Insurance with Profit
Sharing

ICICI Pru LifeTime 105L032V01 ICICI Pru LifeLink II 105L033V01 ICICI Pru LifeLink Pension 105L034V01 ICICI Pru Smart Kid (SP) II 105L035V01
Pension-II II

ICICI Pru Premier Life 105L037V01 ICICI Pru Group Leave 105L039V01 ICICI Pru Invest Shield 105L040V01 ICICI Pru Invest Shield 105L041V01
Encashment Plan Gold Cash

ICICI Pru Invest Shield 105L042V01 ICICI Pru Invest Shield 105L043V01 ICICI Pru Home Assure 105N044V01 ICICI Pru Group Gratuity 105L045V01
Life Pension Plus

ICICI Pru Group 105L046V01 ICICI Pru Group Gratuity 105L046V02 CICI Pru Golden Years 105L047V01 ICICI Pru Group 105L048V02
Gratuity Platinum Platinum Superannuation plus

ICICI Pru Group

Superannuation 105L049V01 ICICI Pru Group 105L049V02 Health Assure 105N050V01 Health Assure Plus 105N051V01
platinum Superannuation Platinum

Cancer Care 105N052V01 Life Link Super 105L053V01 Life Time Plus 105L054V01 Lifetime Super Pension 105L055V01

Lifetime Super 105L056V01 Life Link Super Pension 105L057V01 Smartkid New UL RP 105L058V01 Smartkid New Unit 105L059V01
Linked Single Premium

Cashplus 105L060V01 Premier Life Gold 105L061V01 Investsheild Cashbak 105L062V01 Investsheild Life - New 105L063V01

Diabetes Care (Critical 105N064V01 Diabetes Care Plus 105N065V01 ICICI Pru Credit Assure 105N066V01 Cancer Care Plus 105N067V01
Illness Insurance) (Critical Illness + Life
Insurance)

Hospital Care 105N068V01 ICICI Pru New Group 105L069V01 ICICI Pru New Group 105L070V01 ICICI Pru New Group 105L071V01
Superannuation Superannuation Plus Superannuation Platinum

Crisis Cover 105N072V01 LifeStage RP 105L073V01 Premier Life Pension 105L074V01 LifeStage Pension 105L075V01

Diabetes Assure 105N076V01 CICI Pru LifeTime Gold 105L077V01 Diabetes Care Active 105N078V01 Diabetes Care Active 105N078V02

ICICI Pru Group leave 105L079V01 ICICI Pru Group leave 105L080V01 ICICI Pru Sarv Jana 105N081V01 ICICI Pru Life 105N082V01
Encashment Encashment Plus Suraksha MediAssure

ICICI Pru Life Stage 105L083V01 ICICI Pru Pure Protect 105N084V01 ICICI Pru Wealth 105L085V01 ICICI Pru Anmol Nivesh 105L086V01
Assure Advantage

ICICI Pru Health 105L087V01 ICICI Pru SecureSave 105L088V01 ICICI Pru Group 105N089V01 ICICI Pru Group Gratuity 105N090V01
Saver Superannuation Suraksha Suraksha

ICICI Pru GroupLeave 105N091V01 Accident and Disability 105B001V01 Critical Illness Benefit 105B002V01 Critical Illness Rider 105B003V01
Encashment Suraksha Benefit Rider Rider (Accelarated) (Standalone)

Major Surgical 105B004V01 Level Term Insurance 105B005V01 Accidental Death and 105A006V01 Single Premium Accident 105B007V01
Assistance Rider Rider Disability Benefit Rider and Disability Rider

Single Premium Term 105B008V01 Income Benefit Rider 105B009V01 Accident and Disability 105B010V01 Critical Illness Rider 105B011V01
Rider Benefit Rider With Group (Additional Benefit) With
Term Assurance Group Term Assurance

Accident Benefit Rider 105B012V01 Accident Benefit Rider 105B013V01 Critical Illness Rider 105B014V01 Critical Illness Benefit 105A015V011
with Group Term (Accelerated) With Group Rider (Accelerated) (with
Assurance Term Assurance ICICI Pru SecurePlus,
Cash Plus, Secure Plus
Pension)

Waiver of Premium 105B016V01 Critical Illness Rider 105A017V01 Accident Death and 105A018V01 Waiver of Premium 105A019V01
Rider Disability Benefit Rider Rider

Income Benefit Rider 105A020V01 Diabetes Enhanced 105B021V01 Death Benefit Rider 105B021V01 Diabetes Enhanced 105B022V01
Benefit Rider Benefit Rider

ICICI Prudential Insurance Company Limited.

Communication Address: Vinod Silk Mills Compound,Chakravarthy Ashok Road, Ashok Nagar,Kandivali(E), Mumbai-400 101
Page 2 of 2
Registered Office: ICICI Prulife Towers,1089, Appasaheb Marathe Marg,Prabhadevi,Mumbai-400 025