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Date: 22-Mar-2023

Premium Paid Certificate


Duration For Which the Premium is Received: 01/04/2019 to 31/03/2020
Personal Details
Policy Number: 126039023 Current residential state: Uttar Pradesh
Policyholder Name: Mr. Suyash Mishra Mobile No. 7275044150
Commuinication Address: 10 MISHRANA WARD Landline no. Please inform us for regular updates
AMRAUDHA PIPRI KANPUR Life Insured Name: Mr. Suyash Mishra
.,KANPUR PAN Number: CCYPM4555N
KANPUR - 209112
Email ID: Please inform us for regular
updates

Policy Details
Plan Name: Max Life Monthly Income Advantage Plan - 104N091V01
Policy Term 25 Years Premium Payment Frequency Annual
Date of Commencement 20-JUN-2016 Date of Maturity 20-JUN-2041
Last Premium Due Date 20-JUN-2019 Next Due Date 20-JUN-2020
Reinstatement Interest (incl. ` 909.70 Model Premium (incl. GST) ` 0.00
GST/S.Tax)
Total Premium Received (incl. ` 57,841.86 Minimum Guaranteed Death Benefit / ` 2,94,080.36
GST/S.Tax)* Death Benefit of base plan and term rider
(if any)
Agent's Name Ms. Babita Saxena Agent's Contact No. 9415528893

GST Details
Coverage Type SAC Code CGST/SGST/ GSTIN 09AACCM3201E1Z1
S.Tax (INR) GST Regd. State Uttar Pradesh
Base 997132 ` 0.00
Rider 997132 ` 0.00
Reinstatement Interest ` 138.48
Total ` 138.48

Important Note:
*For payment mode other than in cash, this receipt is conditional upon the credit in our account. Payment of premium amount does not constitute commencement of risk. The risk
commencement starts after acceptance of risk by us. *Amount received would be adjusted against the due premium as per terms and conditions of the policy. *Premiums may be
eligible for tax benefits under section 80C/80CCC/80D/37(1) of the Income Tax Act 1961. Kindly consult your tax advisor for more information. Tax benefits are liable to change due
to changes in legislation or government notification. GST shall comprise of CGST, SGST/UTGST or IGST (whichever is applicable) including cesses and levies, if any. All applicable
taxes, cesses and levies, as per prevailing laws, shall be borne by you. *For GST purposes ,this premium receipt is Tax Invoice. Assessable Value in GST for Endowment First Year
is 25%, Renewal Year is 12.5%; Single Premium Annuity is 10%; Term and Health is 100%.
I/We hereby declare that though our turnover is more than the turnover notified under sub-rule (4) of rule 48, we are not required to prepare an invoice in terms of the said sub-rule.

Authorised signatory

PRM23 V3.0 19012023

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