Ilupa

HEALTH IMSURANCE

Premium Receipt
Dear MR. Kunal Bhanot
B211006. RPS Savana, Sector 88
Faridabad

Haryana-121002

We acknowledge the receipt of payment towards the premium of the following health insurance policy:

Policy Holder's rne Mr. Kunal Bhanot Policy Number 30515407628520

Plan ted for FAMILYFIRST Sum Insured (Rs.) 500,000

Comrrtncement Date 2210512018 Eypiry Date 2110512019

Net Prerni n (Rs.) 51,500.00

Sermce Tax(Rs.) 7,209.59

Swactrth Bharat Cess (Rs.) 258.22

KrishiKalyancess @0.5% 258.22

Loading(Rs.) 0.00

Gross Premium{Rs.) 59,226.02

Issuance of policy is subject to clearance of premium paid

Detallsof personslnsured:

N4•ne of Person l rnured Gender Relatlonshlptopollcyholder Ind6vldual cover(Rs.)

( lYIn ca Of FanilyFlrst)

Mr. Kamal Bhanot 62 Male Father 250,000

Mrs. Meenu Bhanot 60 Female Mother 250,000

UsJ)n issuance of this receipt. all previously issued temsx)rdry receipts if ary, related to this pdicy are considered ndl a 1 void. F(x the
purw)se Ofded tiOn under section 80D, the bene t shall be as per the provisi( S ofthe Income Tax Ac( l%1 a 1 ary amendff*nts made
thereafter.

In the event of non-realization of premium, Tax bene ts cannot be obtained against this premium receipt

For your eligibility and deductions please refer to provisions of Income Tax Act 1961 as modi ed and consult your tax consultant.

Service tax Registration number: AAFCM7916HSTOOI

For and on behalf of Max Bupa Health Insurance Co. Ltd.

Locatlon: New Delhl Ashlshme hrotra

Date: l 010512018 Man4ln8 Dlrertor and Chlef Exbcutlve O cer

Affjx Stamp
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