Premium

17-Dec-2013

Premium Certificate Financial Year 2012 - 2013 To whomsoever it may concern Serial No.

Azeezulla Shaik

0231954617122013

IP 16 Erramanzil Colony Near Ravindra Niketan School Hyderabad Andhra Pradesh Pin:

500082

Phone:

9948800936 9951222786

Client ID:

54558014

This is to confirm that we have received premium(s) from the above named Policy holder under the Policy No (s) as per details given below Policy No:

02319546

Plan Component

Premium(A)

Accidental Death Benefit Rider (UIN-107C001V01) Kotak Capital Multiplier Plan (UIN-107N011V01)

S.Tax(B)* Ed Cess(C)*

Total

80.00

10.00

0.00

90.00

15,120.00

227.00

7.00

15,354.00

* In addition to the amount under (B) and (C), Service Tax and Education Cess computed on applicable charges recovered from the Accumulation account / value of units is Rs.

0.00

The total Service Tax and Education cess collected is Rs. 244.00 Premiums are eligible for tax deduction under Section 80C/80CCC of Income Tax Act,1961. Tax laws are subject to change from time to time. Please consult your tax advisor for implications. Notes: 1 Service Tax, Education Cess and Higher Secondary Education Cess on Service Tax, is levied at the applicable Tax rates in accordance with the prevailing Tax Laws, from time to time. 2

Service Tax Registration Number: AAACO3983BST002.

3

Service Tax Classification: Insurance Auxiliary Service, life insurance services and Management of investment under ULIP services.

1

17-Dec-2013 Thanking you, Yours sincerely, For Kotak Mahindra Old Mutual Life Insurance Ltd.

Authorised Signatory

2