Receipt No.: I00015286918 Receipt Date: 02-Jan-2023 Invoice No.

: HRI022103979930 Invoice Date:02-01-2023

Correspondence address & GSTIN of policyholder: Branch Address & GSTIN of SBI Life:
SH HOSHIAR SINGH Sbi Life Insurance Co Ltd, 2nd Floor, Shop No. 1702, 1703, 1703-A,
S/O Sh Hoshiar Singh, V And P O Saharanwas, Rewari, Haryana, 123401 1704,, Railway Road, Chowk, Rewari,, Rewari Haryana India

Place of supply (State name and code) : HARYANA/6

GSTIN: N.A GSTIN & State Name: 06AAFCS2530P1Z5 and HARYANA/6
HSN Code -997132 HSN Description - Insurance and Pension Services

Life Assured : Mr. Manish Kumar

Assignee: N.A

UIN: 111L095V01 Sum Assured (f): 1000000.00

Policy Number: 1K085788009 Channel: Agency
Plan: SBIL - Smart Wealth Builder - RP and LP Premium Frequency: Annual
Date Of Commencement: 13-Feb-2017 Channel Code: 990636094
Distributor Name: Mr. Suresh Sharma Previous Shortage/Excess (f):
Policy Term: 10 Current Shortage/Excess (f):
Premium Payment Term: 5 Other Charges (f): 0.00

Mode Of Payment Instrument No. Instrument Date Instrument Amount (`) Renewal Adjustment (`)

CSS Online Payment VICI9708635395 02-Jan-2023 100000 100000.00

Received with thanks Rs.100000/- (100000) by way of CSS Online Payment

Total Premium Allocated (f) 100000.00 CGST (f) 0.00
Less: Allocation Charges (f) 6000.00 SGST (f) 0.00

Taxable value of Allocation charge (f) 6000.00 IGST (f) 0.00

Total Allocation Charge with GST (f) 7080.00 KFCT (f) 0.00
Less:- GST on Charges (Whether the tax is payable on reverse charge basis or not - No.) ( ) f 0.00
Net Invested Amount (f) 92920.00

NEXT PREMIUM DUE DATE : -- 02/01/2024

UNIT ALLOCATION STATEMENT
 For updated Investment details, please download fund statement from SBI Life website - Customer Service Portal OR SMS FV <<space>>
(Policy Number) to 56161 OR 9250001848 for latest fund details.

Authorized Signatory

Notes:
 The validity of this receipt is subject to realization of cheque.
 In case of outstation cheques, allocation amount will be done on the date of adjustment of premiums or the realizatin of cheque whichver is later.
 In case of revival of the policy, the risk cover under the base policy and the rider covers if any, will recommence from the date of revival. Any

contingencies which may have happened while the policy was lapzed will NOT be covered even if the claim is made or intimated after the policy has
been revived
 As per GOI registration,GST has been levied on your insurance policy @18% on premium or charges, (or as applicable) w.e.f. 01.07.2017. In the case of

endowment policy, the taxable value is 25% of the premium for first year and 12.5% for second and subsequent year. For single premium annuity
policy, the taxable value is 10% of the premium, pleae refer SBI Life website for details.
 Goods and Service Tax (GST) Cess and/or any other statutory levy/duty/surcharge at the rate notified by the Central Government/State Government/

Union Territories of India from time to time, shall be levied on premium/charges (as applicable) as per rhe provisions of the prevalent tax laws.
 Premium paid under this policy is eligible for tax rebates under 80C of the Income Tax Act, 1961 as applicable.

* -KFCT (Kerala Flood Cess Tax) If applicable effective 1st August 2019 for policies were customer and branch address is same for Kerala state
 Consolidated Stamp duty paid vide Mudrank receipt no. CSD/147/2020/2417 dated 29 Oct 2020

SBI Life Insurance Company Limited

IRDAI Regn. No. 111 CIN: L99999MH2000PLC1291113
Central Processing Centre, 7th Level(D Wing) & 8th Level, Seawoods Grand Central, Tower2 Plot No R-1, Sector 40, Seawoods, Nerul Node, Navi Mumbai 400706
Dist:Thane, Maharashtra

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