Bajaj Allianz Life Insurance Company Limited

GE Plaza, Ground Floor

Airport Road
Yerwada, Pune-411006

0286793395

RENEWAL PREMIUM RECEIPT

Policy Number : 0130250388
Policy Holder Name : MR LAXMAN SINGH

Address :

H.NO. - B - 179J1ST FLOOR, EWS FLAT, C.T. CENTER MARKET~

RAMPRASTHA
GHAZIABAD
UTTAR PRADESH
201011

Receipt No. 0286793395 Payment Date 21/01/2010

Received with thanks from MR LAXMAN SINGH

Gross Amount (in Rs.) 12000

Amount in Rs.(in Words) Twelve Thousand Only

Mode of payment Credit Card

12000
Premium Amount Rs.

Product Name CENTURY PLUS 2

Name of Life Assured MR LAXMAN SINGH

16/07/2009
Date Of Commencement Deposit B/F N/A Service Tax 0.0
Education
Date Of Maturity 16/07/2019 Deposit C/F N/A 0.0
Cess
Higher Edu.
Mode Half Yearly X Change B/F 0.0 0.0
Cess
Late Fees

STM CODE 1100088512 I.C Code 1001031526

NEXT PREMIUM DUE DATE 16-JAN-2010

MUDRANK No. 25993 Dated 20/08/2008

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: 1800 209 7272

Email Us: renewalvertical@bajajallianzlife.co.in or life@bajajallianzlife.co.in Bharti: 1800 103 7272, Reliance: 1800 3000 7272

Customer Copy