Absli 3140206

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Dear SAKTHIVEL P G

Thank you for choosing Aditya Birla Sun Life Insurance as your preferred insurance partner for securing your family’s future. Your
premium amount of Rs. 49,592.52 has been received. The details are as follows:

SAKTHIVEL P G RENEWAL PREMIUM Rs. 48,501.26


403
GOLDEN GATE APARTMENTS
SANKARA COLLEGE ROAD
SARAVANAMPATTI
COIMBATORE
641035 12.50% of Premium Rs.6062.65
CGST(9.00%) Rs. 545.63
State Code:33 SGST(9.00%) Rs. 545.63
Total Amount Rs. 49,592.52
Amount in Words : Rupees Fourty Nine Thousand Five Hundred
Ninety Two And Paise Fifty Two only

Receipt No: 101935218


Payment Received from : SAKTHIVEL P G SAC Code:997132
Owner Name : SAKTHIVEL P G SAC Desc:Life Insurance
Modal Premium and Mode: Rs. 49592.52, Annual
Policy Number: 006647617
Plan Name: NA Policy/Premium Paying Term: 20 Years
Payment : Card
Remark :
Requirements for Revival if any :
Next Due Date : 12/12/2020

Signature Not Verified


Insurance Advisor: 001136 THE KARUR VYSYA BANK LTD Digitally signed by DS ADITYA BIRLA SUN LIFE
INSURANCE COMPANY LIMITED 1
Date: 18/12/2019 12:00 Date: 2019.12.18 12:00:43 IST
Branch Name and Address:G - CORP TECH PARK,5TH FLOOR KASAR Reason: I am authorizing this receipt.
Location: ABSLI, MUMBAI
VADAVALI,GHODBUNDER ROAD,THANE WEST 400 601 TEL 3996 1000
State Code:33
Supplier GSTIN:33AABCB4623J1ZZ

Consolidated revenue stamp duty has been paid by demand draft vide receipt number MH006361809201920E dated 09/10/2019.

This Receipt is only Acknowledgment of payment. GST Compliant Receipt will be shared separately.

1 For premium received online, vide local cheque or demand draft before 3:00 pm, NAV, of same day will be applied and premium received online, vide local cheque or
demand draft after 3:00 pm, NAV, of the next business day will be applicable.
2 Any sum paid on insurance policy with Aditya Birla Sunlife Insurance Company Limited would be eligible for applicable tax benefits, under the Income Tax Act, 1961, as
amended from time to time. For specific suitability you are requested to consult your tax advisor.
3 W.e.f 1st July 2017,GST will be levied on Life Insurance Premium as per the applicable tax rates.

NACH/Direct debit Submit the duly completed NACH/Direct debit form and an original cancelled cheque with MICR code at your nearest Branch Office
Net banking - To make payments online, visit our website www.adityabirlasunlifeinsurance.com (Over 55 banks to choose from)

Visit www.adityabirlasunlifeinsurance.com, download the ‘Policy Service Request Form’, submit the duly completed form at your nearest branch office and enjoy the following
benefits:
• Instant access to policy updates • Paperless record of all your policies

Aditya Birla Sun Life Insurance Company Limited


(Formerly known as Birla Sun Life Insurance Company Limited)
Write to us at: Customer Service, Aditya Birla Sun Life Insurance Company Limited, G Corp
Tech Park, 6th Floor, Kasar Wadavali, Ghodbunder Road, Thane - 400601.
Regd Office: One Indiabulls Centre, Tower 1, 16th Floor, Jupiter Mill Compound,
841, Senapati Bapat Marg, Elphinstone Road, Mumbai - 400013
+91 22 6723 9100 | care.lifeinsurance@adityabirlacapital.com |
adityabirlasunlifeinsurance.com | CIN: U99999MH2000PLC128110 | Regn. No.: 109.

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