Date: 15/6/2022

Mrs. Hemavathy R
52,25th Street,
GKM Colony,
Chennai,
Tamil Nadu
600082
PREMIUM PAID CERTIFICATE FOR THE YEAR 2022-2023

This is to certify that as per our records the following payments have been received by us to effect
or keep "In Force" Life Insurance Policies held by
Mrs. Hemavathy R

Life Assured’s Name: Hemavathy R

Policy No.: 17423530 Plan Name: Life Stage Pension

Benefits/Rider Sum Assured Coverage Premium Amount Premium Due UIN

Life Stage Pension 0.00 SEC 80 CCC(1) 50,000.00 0.00 202M075V04

Policy Total 50,000.00

Amount in 0.00
Suspense
Total Premium 50,000.00
Premium Due 0.00

Premium Paid to avail Income Tax Benefits Under:

SEC 80 CCC(1) 50,000.00

SEC 80 C 0.00
SEC 80 D 0.00

Total 50,000.00

Please note the mortality charges under the base plan as well as riders (if any) would be recovered every
month as per the Terms and Conditions of the Policy.

The above mortality charges are the actual charges recovered till date. The recovery of such charges would
be subject to change on monthly basis.

This is a computer generated statement and does not require any signature.
 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
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