Consolidated Premium Receipt (Chosen Policy)

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Date: 08-May-2024

Duration For Which the Premium is Received: 19/09/2019 to 08/05/2024


Personal Details
Policy Number: 333790376 Current residential state: Telangana
Policyholder Name: Ms. Satya Devi Geddam Mobile No. 9989033678
Commuinication Address: PLOT 62 SANCHARPURI Landline no. Please inform us for regular updates
COLONY Life Insured Name: Ms. Satya Devi Geddam
PHASE 1 OLD AIRPORT PAN Number: AKOPG7250L
ROAD
NEW BOWENPALLY
SECUNDERABAD
Hyderabad - 500011
Email ID: stgddm@gmail.com
Policy Details
Plan Name: Max Life Smart Term Plan - 104N113V01
Policy Term 50 Years Premium Payment Frequency Annual
Premium Payment Term 25 Years Date of Maturity 19-SEP-2069
Date of Commencement 19-SEP-2019 Next Due Date 19-SEP-2024
Last Premium Due Date 19-SEP-2023 Model Premium (incl. GST) ` 31,390.76
Reinstatement Interest (incl. ` 0.00 Total Sum Assured of base plan and term ` 1,00,00,000.00
GST/S.Tax) rider (if any)
Total Premium Received (incl. ` 1,57,644.54 Agent's Contact No.
GST/S.Tax)*
Agent's Name Axis Bank Ltd Kompally

GST Details
Coverage Type SAC Code CGST/SGST/ GSTIN 36AACCM3201E1Z4
S.Tax (INR) GST Regd. State Telangana
Base 997132 ` 4,144.54
Rider 997132 ` 0.00
Reinstatement Interest ` 0.00
Total ` 4,144.54

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%. *Supply meant for Export under Letter of Undertaking without payment of Integrated
Tax. *whether the tax is payable on reverse charge basis - No.
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 V3.2 23012024

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