Online Receipt Print

Bajaj Allianz Life Insurance Company Limited GE Plaza, Ground Floor Airport Road Yerwada, Pune-411006

0548336420

RENEWAL PREMIUM RECEIPT Policy Number : 0294648294 Policy Holder Name : MR JAYANTA MAITY

Address : C/O -SOIBAL CHATTERJEE HARHPO+PS-~GHATAL VILL-KUSHPATA WEST MIDNAPORE WEST BENGAL 721212

Receipt No.

0548336420

Payment Date

26-FEB-2014

Received with thanks from

MR JAYANTA MAITY

Gross Amount (in Rs.)

25000

Amount in Rs.(in Words)

Twenty Five Thousand Only

Mode of payment

Online Net Banking(Trans ID-MHDF3267601588)

Premium Amount Rs.

25000

Product Name

LIFE_ASSURE_PLAN_MORE

Name of Life Assured

MR JAYANTA MAITY

Date Of Commencement

11/02/2013

Deposit B/F

N/A

Service Tax

0.0

Date Of Maturity

11/02/2023

Deposit C/F

N/A

0.0

Mode

Annual

X Change B/F

0.0

Education Cess Higher Edu. Cess

1100075947

I.C Code

0.0

Late Fees STM CODE

NEXT PREMIUM DUE DATE

1002298772

10-FEB-2015

MUDRANK No. 1500/299 Dated 18/06/2013

Utilization shall be done as per applicable IRDA Guideliness in this regards Advance premium collected shall be utilized on premium due date.Amount held in deposit will not attract any interest.For eligibility under applicable sections of Income Tax Act 1961. Please refer relavant provisions and rules.

Visit our website:

www.bajajallianzlife.co.in

BSNL:

1800 233 5858,

Tata:

Email Us:

[email protected] or [email protected]

Bharti:

1800 103 7272,

Reliance: 1800 3000 7272

Customer Copy

1800 209 7272