Renewal Premium Receipt - ULIP

Receipt No : I00044642946 Receipt Date : 01-08-2023

Mrs. Jothiammal N Branch Details: DHARMAPURI
SBI LIFE INSURANCE CO LTD
1ST FLOOR, SAI TOWERS, NO. 10/1
PIDADMANERI MAIN ROAD, DHARMAPURI
DHARMAPURI
TAMIL NADU
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 : Mrs. Jothiammal N
Assignee : N.A.

Policy Details
UIN: 111L095V02 Sum Assured: 500000
Policy Number: 1K354811706 Channel: Agency
Plan: SBIL Smart Wealth Builder SERIES II - RP and Distributor Name: Mr. K Paventhan
LP
Date of Commencement: 31-07-2020 Channel Code: 990912159
Premium Frequency: Annual
Policy Term: 15 Premium Paying Term: 7

Received with Thanks Rs.50000.00/- (Fifty Thousand Only.) by way of NACH Payment

Total Premium Allocated(Rs.) 50,000.00

Less:- Allocation Charges(Rs.) 3000.00
Less:- GST on Charges(Rs.) 540
CGST: 270.00 SGST/UGST: 270.00 IGST: 0.00
Net Invested Amount(Rs.) 46,460.00

Next Premium Due Date : 31/07/2024

UNIT ALLOCATION STATEMENT

Opening Balance Amount Invested Closing Balance
Fund Name SFIN NO NAV Units Fund % Units Fund Units Fund Value
Value Value
SBI Life Equity Fund ULIF001100105EQUITY- 155.8469 559.4089 87182.14 50 149.0565 23229.99 707.7272 110297.09
FND111
SBI Life Bond Optimiser ULIF032290618BONDOPTFND 18.5243 4076.094 75506.80 50 1254.028 23230.00 5324.5696 98633.92
Fund 111 9 5
Total 162688.9 100 46459.99 208931.01
4

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.)