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Mediclaim Policy - Self

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Premium Certificate

We confirm the receipt of premium amount of INR 16548 as per below details paid by Mr. AMOL SURESH BACHHAV for Self and/or Family and/or
Parents:

Policy Number: 23-23-0008999-00 Plan Name: Platinum - Enhanced

Mr. AMOL SURESH BACHHAV


Type of Plan: Family Floater Proposer Name:

Policy Start Date: 00:00 hrs on 09/06/2023 Policy End Date: 23:59 hrs on 08/06/2024

Receipt Details:

Receipt Number Receipt Amount Instrument Number Dated Relationship Payment Mode Bank Name

R72049679 16548.00 pay_H2onkrkZ2EAku 04/06/2023 Self Online HDFC BANK

Mode of Premium payment Single

Year wise breakup of premium for the purpose of claiming Income Tax deduction u/s 80D (subject provisions of Income Tax Act) is provided as under:

Financial Year Year wise proportionate Premium amount*


2023-24 16,548.00

‘* Premium paid in cash and premium paid towards Personal Accident, Wellness Coach do not qualify for deduction u/s 80D. Further premium paid for person
other than family member & parents (as defined under Income Tax Act) also don’t qualify for deduction under section 80D.

Amount is rounded off to nearest rupee and is inclusive of all taxes and cesses as applicable. For exact premium, please refer to Section VIII of Policy
schedule
Note:
1. The year wise deductions as mentioned above are as per provision of Section 80D and this would be subjected to the specified annual limits and other
provisions as applicable for respective years as per applicable provisions of Income Tax Act.
2. Deduction under section 80D of the Act is allowed to the person who pays premium out of his/her income chargeable to tax.
3. Deduction under section 80D of the Act is available on realization of premium paid by Policyholder.
4. Tax laws are subject to change and any such change could have a retrospective effect. This letter should not be construed as tax, legal or investment
opinion from us. For specific suitability, you are requested to consult your tax advisor.
5. This receipt must be surrendered to the company, in case of cancellation of this policy. In event of incorrect representation of this declaration the liability
shall be upon the policy holder.

For and on behalf of Aditya Birla Health Insurance Co. Limited

Date : 08/06/2023

Place : Mumbai

Authorized Signatory

Active Health UIN: ADIHLIP21574V032023

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