Renewal Premium Receipt - NON ULIP

Receipt No : BLA-BANGALORE Receipt Date : 20-09-2022 Invoice No.: KAI092200063016 Invoice Date.:20-09-2022
2/I00033597848
Mr. Manikanda Prabhu Branch Details: BANGALORE 2
SBI LIFE INSURANCE CO LTD
Plot No. 96/04, 3rd Floor,
Chandrasales, South End Road, Basavangudi,
BANGALORE
Place of Supply (State name & Code): KARNATAKA/19 TAMIL NADU
GSTIN: N.A. GSTIN & State Name: 33AAFCS2530P1Z8 KARNATAKA/19
HSN CODE : 997132 HSN Description - Life Insurance Services
Please note that your servicing branch has shifted. The new address of your servicing branch is given above.
You may approach either your servicing branch or any of our other branches for all your servicing needs and premium payment.
Life Assured : Mr. Manikanda Prabhu
Assignee : N.A.

Policy Details
UIN: 111N096V03 Policy Number: 1N392173804
Plan: SBIL - Smart Money Back Gold III Regular Date of Commencement: 12-10-2021
Premium Frequency: Monthly Channel: Agency
Policy Term: 15 Distributor Name: Mr. Manohar Reddy M
Premium Payment Term: 15 Channel Code: 990469603
Sum Assured: 700000.00 Payment Type: Renewal

Premium Details
Base Amount(Rs.) CGST(Rs.) SGST/UGST(Rs.) IGST(Rs.) Total Amount(Rs.)
Premium(Rs.) 5082.49 0.00 0.00 228.71 5311.20
Late Fees#(Rs.) 0.00
Previous Excess(Rs.) 0.00
Total Amt Payable(Rs.) 5311.20
Amount Received(Rs.) 5311.00
Current -0.2
Excess/Shortage(Rs.)

Received with Thanks Rs.5311.00/- (Five Thousand Three Hundred Eleven Only.) by way of Easy Access

Next Premium Due Date : 12/10/2022

Authorized Signatory

Notes:
- #-Late fees is inclusive of GST if applicable.
- The validity of this receipt is subject to realization of cheque. The amount held in policy deposit does not earn any interest.
- 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.
- GST Registration Number 33AAFCS2530P1Z8. HSN Code & Description: 997132 & Life Insurance Services
- As per GOI Notification, 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. Please refer SBI Life website for deails.
- 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 lapsed will NOT be covered even if the claim is made or intimated after the policy has been revived.
- Consolidated Stamp duty paid vide Mudrank receipt no CSD/425/2022/3416 03-08-2022

SBI Life Insurance Company Limited

IRDAI Regn No. 111. CIN: L99999MH2000PLC129113.
Central processing Centre: 7th Level(D Wing) & 8th Level, Seawoods Grand Central, Tower 2 Plot No R-1, Sector 40, Seawoods, Nerul Node, Navi Mumbai-400706
Dist. Thane, Maharashtra, Website - www.sbilife.co.in & Email at info@sbilife.co.in
Toll free no. : 1800 267 9090 (Customer Service Timings: 9:00 a.m. to 9:00 p.m.)