PremiumCertificate_57086831 (4) Kotak

02-01-2018

Premium Certificate Financ ial Year 2017-20 2017-2018 18 To whomsoever it may concern Dharmendra Kumar Sharma  A 460 Krishna Nagar Bagu Byepass Vijay Nagar Nr Rose Belly Public School Ghaziabad Uttar Pradesh Uttar Pradesh Pin: 201009 Phone1: Phone2: 9015150192

Client ID: 57086831 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: 02913518 Pl an Co m p o n en t

Pr em i u m (A )

Kotak Assured Income Plan (UIN-107N069V03)

30600

S.Tax /GST(B )*

Cess, as applicable(C)*

612

20

Policy No: 03072609 Pl an Co m p o n en t

Pr em i u m (A )

Kotak Premier Money Back Plan (UIN-107N083V01)

10185

S.Tax /GST(B )*

Cess, as applicable(C)*

229

-

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.  Ad di ti on al Pr emi um du e fo r Fi nan ci al Year 2017-2018 Po l i c y

Pl an Co m p o n en t

Pr em i u m Du e

Pr em i u m Du e Dat e

Fr eq u en c y

03072609

Kotak Premier Money Back Plan (UIN-107N083V01)

10414

19-Mar-2018

Half Yearly

1

02-01-2018 Notes:

1 Goods and Services Tax and Cess, as applicable is levied at the tax rates in force which is subject to changes from time to time. 2 Goods and Services Tax category: Life Insurance Services and Management of Investment under ULIP Services. 3 Goods and Services tax is applicable from 1st July' 2017. 4 This is a computer generated advice and does not require any signature. 5 In order to abide by the Foreign Account Tax Compliance Act (FATCA), kindly submit Insurance FATCA Declaration, separately, if the answer to any of these questions is a `yes': (i) Are you a citizen of any other country apart from India (dual or multiple citizenship); (ii) Are you a resident (for tax purposes) of any other country other than India; (iii) Do you hold a green card of USA or any similar card for any other country? It is mandatory for you to report any future changes in your tax status to Kotak Life Insurance within 30 days of such change. Until we receive a written intimation about any such change, we shall presume that there is no change in your tax residency status and consider your earlier submitted declarations, if any, as valid. For any queries about your tax residency, please contact your tax advisor.

2

02-01-2018

Premium Payment History Policy No

Receipt No

Paid Date

Paid Amount

Frequency

02913518

AT861267

10-Nov-2017

15644

HALF YEARLY

02913518

AR704673

10-May-2017

15588

HALF YEARLY

03072609

AT668042

20-Sep-2017

10414

HALF YEARLY

3