Premium Receipt

Dear Mr. Raghuveer V

V3 Kristal Campus 10,
Bangalore, Karnataka-562125
We acknowledge the receipt of payment towards the premium of the following health insurance policy:
Policy Holder's Name Mr. Raghuveer V Policy Number 30209660202200

Plan Opted for Reassure Silver 10 Sum Insured (Rs) 10,00,000

Commencement Date 20/05/2022 Expiry date 19/05/2023

Net Premium (Rs.) 22,282.00
CGST @9% (Rs.) 2,005.00
SGST @9% (Rs.) 2,005.00
Stamp Duty (Rs.) 1.00
Gross Premium (Rs.) 26293.00
*Stamp Duty
*Insurance policy is subject to clearance of premium paid

Details at persons Insured:

Name of person Insured Age Gender Relationship to policy holder Individual Cover(Rs.)

Mr. Raghuveer V 26 M Applicant 10,00,000

Upon issuance of this receipt, all previously issued temporary receipts, if any, related to this
policy are considered null and void. For the purpose of deduction under section 80D, the benefit
shall be as per the provisions of the Income Tax Ad, 1961 and any amendments made thereafter.
In the event of non-realization of premium, Tax benefits cannel be obtained against this premium
receipt.
For your eligibility and deductions please refer to provisions of Income Tax Act 1961 as
modified and consult your tax consultant.

GSTIN number. 29AAFCM7916H1Z4

For & On behalf of Max Bupa Health Insurance Co. Ltd.

Ashish Mehrotra
Managing Director & Chief Executive Officer
Location : Bangalore
Date: 19/05/2022