PREMIUM RECEIPT

Date : 19-Dec-2021

Personal Details
Plan Name: Tata AIA Life Insurance Diamond Savings Plan
Policy Number: C110329231
(110N133V01)
Policy Owner Name: KARTHIKEYAN M Life Assured Name: KARTHIKEYAN M
PAN: ASSPK5533C NEFT: Updated
Email: KARTHIKM07@GMAIL.COM Contact Number: 9611432137
Agent Name: Usha Madan Agent Contact Number: 9620592888

Policy Details
Premium Amount Due: ` 23,000.00 Payment Mode: Annual
Goods and Service Tax (GST): ` 518.00 Next Premium Due: 19-12-2022
Total Amount Due: ` 23,518.00 Excess Amount*: ` 0.00
Amount Received: ` 23,518.00

Tax Benefit Details

Tax Applicable under Sec 80 C Tax Applicable under Sec 80 CCC Tax Applicable under Sec 80 D
` 23,517.00 ` 0.00 ` 0.00

Payment Details
Receipt Number Receipt Date Amount Payment Method
ARC268335 19-Dec-2021 ` 23,518.00 Autodebit from Bank Account

Please Note:
⦁ This document can be used as proof for claiming deduction while filing your tax returns and tax benefits would be
applicable as per the prevailing tax laws.
⦁ Payment which have been made other than cash are subject to clearance including through electronic mode
payments.
⦁ Any excess premium will be adjusted towards premium due in the current financial year or due in the next three
months, whichever is later. Else premium will be auto refunded post 15 days.
⦁ Applicable govt taxes, surcharge, cess including GST would be charged in accordance to applicable laws and company
will have the right to recover the same from the policy holder.
⦁ Please refer policy document for detailed terms and conditions.

GST Details
Base Premium Taxable Value SGST/UTGST 9.00% CGST 9.00% IGST 0.00% Reverse Charge

` 23,000.00 ` 2,875.00 ` 258.50 ` 258.50 ` 0.00 N

Tata AIA Life Insurance State KARNATAKA Tata AIA Life Insurance GST IN 29AABCT3784C1Z9 SAC Description Life Insuarance
Policy Owner’s GST State KARNATAKA Policy Owner’s GSTIN NOT REGISTERED SAC Code 997132

Consolidation Revenue stamp duty paid: Notification No. Mudrank – CSD/126/2021/3176/21_Dtd.26 August 2021 vide
receipt number MH005113203202122E dated on 26-August-2021.

*Excess Amount is balance available with us after adjusting for outstanding premium and late payment fee (if any).
L&C/Misc/2021/Aug/0447