Date: 31-MAR-2023

Premium Paid Certificate

Duration For Which the Premium is Received: 27/08/2022 to 31/03/2023
Personal Details
Policy Number: 114925787 Current residential state: Karnataka
Policyholder Name: Mr. Saket Tiwari Mobile No. 9620413170
Commuinication Address: 003 AKSHARA ASPIRE Landline no. Please inform us for regular updates
APARTMENT NAGARAJ Life Insured Name: Mr. Saket Tiwari
LAYOUT VIJAYNAGAR PAN Number: AMMPT5010B
ROAD
WHITEFIELD
NEAR MURGUN TEMPLE
Bengaluru - 560066
Email ID: sakettiwari1988@gmail.com

Policy Details
Plan Name: Max Life Smart Secure Plus Plan - 104N118V04
Policy Term 32 Years Premium Payment Frequency Semi-Annual
Date of Commencement 27-AUG-2022 Date of Maturity 27-AUG-2054
Last Premium Due Date 27-AUG-2022 Next Due Date 27-FEB-2023
Reinstatement Interest (incl. ` 0.00 Model Premium (incl. GST) ` 7,722.25
GST/S.Tax)
Total Premium Received (incl. ` 7,722.17 Total Sum Assured of base plan and term ` 1,00,00,000.00
GST/S.Tax)* rider (if any)
Agent's Name Internet Sales Agent's Contact No.

GST Details
Coverage Type SAC Code IGST/S.Tax GSTIN 06AACCM3201E1Z7
(INR) GST Regd. State Haryana
Base 997132 ` 1,131.28
Rider 997132 ` 46.61
Reinstatement Interest ` 0.00
Total ` 1,177.89

Important Note:
*For payment mode other than in cash, this receipt is conditional upon the credit in our account. Payment of premium amount does not constitute commencement of risk. The risk
commencement starts after acceptance of risk by us. *Amount received would be adjusted against the due premium as per terms and conditions of the policy. *Premiums may be
eligible for tax benefits under section 80C/80CCC/80D/37(1) of the Income Tax Act 1961. Kindly consult your tax advisor for more information. Tax benefits are liable to change due
to changes in legislation or government notification. GST shall comprise of CGST, SGST/UTGST or IGST (whichever is applicable) including cesses and levies, if any. All applicable
taxes, cesses and levies, as per prevailing laws, shall be borne by you. *For GST purposes ,this premium receipt is Tax Invoice. Assessable Value in GST for Endowment First Year
is 25%, Renewal Year is 12.5%; Single Premium Annuity is 10%; Term and Health is 100%.

Authorised signatory

PRM23 V2.9 01082019