LIFE INSURANCE PREMIUM CERTIFICATE

( Financial Year 2015 -2016 )

DUTTA KOUSHIK
BLK I GOLAB BHAWAN II FLR
BOSENAGAR GATE PS MADHYAMGRAM
DIST NORTH 24 PARGANAS
KOLKATA
WEST BENGAL
ZIP: 700129
PHONE: 25269748

This is to certify the following details:

Policy Number U200586078 Basic Plan Tata AIA Life InvestAssure II (110L048V01)

Insured Name DUTTA KOUSHIK Policyowner Name DUTTA KOUSHIK

Face Amount Mode of Premium ANNUAL

500,000.00
(Rs/Units)

Tax Sections # Amount (Rs.) Service Tax (Rs.) Total (Rs.)

80 C of Income Tax Act, 1961 * 100,000.00 0.00 100,000.00
80 CCC of Income Tax Act, 1961** 0.00 0.00 0.00
80D of Income Tax Act, 1961 *** 0.00 0.00 0.00

Total amount of premium paid during the Financial Year 2015-2016 : 100,000.00

* Includes Life Plans and Riders.

** Includes Pension Plans. Tax benefit not available for premium payment through automatic loans from Cash Value of the policy
if any, as per the policy provisions.
*** Includes Health Plans & Health Riders. Tax benefit not available for premium payment in cash or through automatic loans
from Cash Value of the policy if any, as per the policy provisions.
Date: 13 Aug,2016 For Tata AIA Life Insurance Company Limited

Authorized Signatory

Service tax is payable on life insurance premium as per section 65(105)(zx)of finance Act (No 2), 1994 as amended by Finance Act (No 2), 2004 at applicable rates
as per circular number F.No.B2/8/2004-TRU (Tax Research Unit) Dated 17th September 2004 issue by Government of India,
Ministry of Finance and subsequent directions issued by the authorities from time to time.'STC no: ABCT3784CST0001, Reg. No: M-IV/ST/IAS-LIFE/14
Category: RISK COVER IN LIFE INSURANCE SERVICE

Please note that we do not recognize as payment, whether received in cash or cheque or other forms, if it is not honored or cleared by a bank or not acceptable to
the company.

# Income Tax benefits would be available as per the prevailing income tax laws.

Tata AIA Life Insurance Company Ltd.

Regd. & Corporate office: Delphi- B Wing, 2nd Floor, Orchard Avenue,Hiranandani Business Park,Powai, Mumbai-400 076 .

Please feel free to contact us at our customer service toll free number 1-860-266-9966 (Local Charges Apply)