Contribution Billing

Issue Date : March 2, 2024

Membership Period : April 1, 2024 To September 30, 2024
Bill No : 0320240216158
Bill Code : Final
Scheme No : 102016000000000004377
Participant/Proposal No : 000000000004377 / 08
Participant : BLUE ZORRO (PRIVATE) LIMITED
Billed Upto Endorse No. : 6

-H&R* = Hospital & Related Limit (Per Annum)

No. of Room & Pre- Post- Normal Complicated

Benefits Lives H&R * Board Hospital Hospital Delivery Delivery
(per day) Diagnosis Follow Up

Plan A 44 200,000 9,840 200,000 200,000 40,000 80,000

No. of Persons Covered : 44 (Lives)

Contribution Position
Contribution for the period 01/10/2023 to 30/09/2024 319,534
Contributionfor the period 01/10/2023 to 31/03/2024 151,449
Contribution for the period 01/04/2024 to 30/09/2024 168,085
Contribution Fluctuation for the period 01/10/2022 to 30/09/2023 23,559
Amount of Due Contribution 343,093
Contribution Received (170,334)
Contribution Payable 172,759

Note: This is a system generated Bill and does not require signature.

* Contribution rates, benefits etc. quoted here are subject to changes at the time of final contribution billing due to change in incurred claims,
changes in employees data etc.
* *Without prejudice to the Company's Constitution Petition(s) pending in the High Court of Sindh, if Sindh Sales Tax is found to be applicable, the
Note same shall be invoiced separately.

Please make sure the cheque is made in favour of JLI Accident & Health Family Participant Takaful Fund

For Jubilee Life Insurance Company Limited Window Takaful Operations Use Only
Contribution Commencement 302,897
Fluctuation of Current Scheme Period 16,637
Amount of Contribution for the period 01/10/2023 to 30/09/2024 319,534
Amount Already Billed Vide Our Previous Bill # 205421 151,449
Contribution Of This Bill 168,085

Issued By: RPA

Group Health Department , Jubilee Life Insurance Company Limited 74/1-A, Lalazar M.T. Khan Road Karachi-74000, Pakistan.
Phone (021) 02135205095, , Facsmile : (021) 35610805, 35610959. Webpage : www.jubileelife.com NTN. 0660564-8