STATEMENT OF ACCOUNT AS ON 12-APR-2018

BAJAJ ALLIANZ CAPITAL UNIT GAIN ACCOUNT

To, Statement Date : 12-APR-2018

MR MOHAMMAD SAZID ALAM Policy No : 0052654976
, Issued Date : 28/05/2007
VILLAGE POST JOKATIA~NEAR MOSQUE Sum Assured : 100000
MAJHOLIA, WEST CHAMPARAN Frequency of Payment : Annual
BIHAR Premium Amount : 10000

Surrender Penalty applicable as on statement date is 35.95 % of the value of the outstanding Capital units.

BAJAJ ALLIANZ EQUITY GROWTH FUND SFIN Code:ULIF02924/07/06EQGROWFUND116

Transaction Req ID Transaction Amount Allocation Net Unit Price Allocated Units
Date Rate % Investment
(Rs)
29-MAY-07 New Business 9000 95 8550.00 12.8950 663.0477
Regular(Capital Units)
30-JUN-08 Lapse Capital Withdrawal - -6707.27 11.6330 -576.5925
Regular
13-AUG-08 Regular Premium Renewal 9000 95 8550.00 12.8130 667.291
Year
13-AUG-08 Reinstatement Capital - 6707.27 12.8130 523.4739
Regular
30-JUN-09 Lapse Capital Withdrawal - -13425.75 12.3380 -1088.1439
Regular
18-JUL-11 Regular Premium Renewal 9000 95 8550.00 16.8118 508.5714
Year
18-JUL-11 Regular Premium Renewal 9000 95 8550.00 16.8118 508.5714
Year
18-JUL-11 Regular Premium Renewal 9000 95 8550.00 16.8118 508.5714
Year
18-JUL-11 Reinstatement Capital - 13425.75 16.8118 798.5908
Regular
30-MAY-12 Regular Premium Renewal 9000 95 8550.00 15.9535 535.9326
Year
09-JUL-12 3710026 Partial Withdrawal Regular - -29000.00 16.7909 -1727.126
20-MAR-14 Regular Premium Renewal 9000 95 8550.00 21.2108 403.0965
Year
20-JAN-15 Regular Premium Renewal 9000 95 8550.00 31.2616 273.4985
Year
30-NOV-16 Regular Premium Renewal 9000 95 8550.00 30.5709 279.6777
Year
Transaction Req ID Transaction Amount Allocation Net Unit Price Allocated Units
Date Rate % Investment
(Rs)
30-NOV-16 Regular Premium Renewal 9000 95 8550.00 30.5709 279.6777
Year
19-JUL-17 8245889 Partial Withdrawal Regular - -50000.00 36.9628 -1352.7114
24-JUL-17 Regular Premium Renewal 9000 95 8550.00 37.0454 230.7979
Year
Charges -14246.32 -723.7266
Balance c/f 712.4981

BAJAJ ALLIANZ LIQUID FUND SFIN Code:ULIF02510/07/06LIQUIDFUND116

Transaction Req ID Transaction Amount Allocation Net Unit Price Allocated Units
Date Rate % Investment
(Rs)
29-MAY-07 New Business 1000 95 950.00 10.6670 89.0597
Regular(Capital Units)
30-JUN-08 Lapse Capital Withdrawal - -909.90 11.8270 -76.9074
Regular
13-AUG-08 Regular Premium Renewal 1000 95 950.00 11.9460 79.5245
Year
13-AUG-08 Reinstatement Capital - 909.90 11.9460 76.1677
Regular
30-JUN-09 Lapse Capital Withdrawal - -1870.68 13.0660 -143.181
Regular
18-JUL-11 Regular Premium Renewal 1000 95 950.00 15.1096 62.8739
Year
18-JUL-11 Regular Premium Renewal 1000 95 950.00 15.1096 62.8739
Year
18-JUL-11 Regular Premium Renewal 1000 95 950.00 15.1096 62.8739
Year
18-JUL-11 Reinstatement Capital - 1870.68 15.1096 123.8074
Regular
30-MAY-12 Regular Premium Renewal 1000 95 950.00 16.2740 58.3753
Year
20-MAR-14 Regular Premium Renewal 1000 95 950.00 18.9275 50.1915
Year
20-JAN-15 Regular Premium Renewal 1000 95 950.00 20.2869 46.8282
Year
30-NOV-16 Regular Premium Renewal 1000 95 950.00 23.3508 40.6838
Year
30-NOV-16 Regular Premium Renewal 1000 95 950.00 23.3508 40.6838
Year
24-JUL-17 Regular Premium Renewal 1000 95 950.00 24.2419 39.1883
Year
Charges -2463.99 -137.6802
Balance c/f 475.3633
Summary Details
Fund Name & SFIN Code NAV Top Up Top Up Regular Regular Capital Unit
Premium Premium Fund Premium Premium Fund
Units 1321 value 4564 Units value
EQUITY GROWTH FUND 39.8412 0.0000 0.00 712.4981 28386.78 194.1374
ULIF02924/07/06EQGROWFUND116
LIQUID FUND ULIF02510/07/06LIQUIDFUND116 25.1611 0.0000 0.00 475.3633 11960.66 41.4851
Total 0.0000 0.00 1187.8614 40347.44 235.6225

* Account Value Rs 40347.44 ..................

Note : This is a computer generated letter. No signature is required.

* "Account Value" is based on NAV available on 11/04/2018.
Note: Charges Include Mortality charge.Policy admin charges,Service tax/GST (CGST,SGST/UTGST,IGST as
applicable),Switch fee where ever applicable.
In compliance of the provisions relating to deduction of tax at source under section 194 DA
of Income Tax Act, 1961 as introduced by Finance Act, 2014, any payment (except payment exempted u/s 194DA)
made by Bajaj Allianz Life Insurance Company Limited shall be subject to deduction of applicable TDS.
In absence of PAN details, TDS would be deducted @ 20% instead of 1% in case where PAN is provided.
TDS once deducted shall not be refunded.
Please update your PAN immediately. Kindly ignore if PAN details already provided.
For further details, please consult your Income Tax advisor/consultant.
As opted, your policy continues with benefits till such time the regular premium fund value less surrender charges, remains
above the relevant premium threshold.