LIFE INSURANCE PREMIUM CERTIFICATE

(Financial Year 2018-2019)

SEBASTIN RAJU Date : 27-03-2019

29/A,,RAMAN STREET, ALLAMPATTI
VIRUDHUNAGAR,
VIRUDHUNAGAR - 626001
State : TAMIL NADU
Phone :

This is to certify the following details:

Policy Number C209929539 Basic Plan Tata AIA Life Insurance Fortune Guar
antee (110N120V05)
Insured Name SEBASTIN RAJU Policyowner Name SEBASTIN RAJU
Mode of Premium ANNUAL Base Sum Assured/Units 500000.00
Date of Issuance 19-03-2019 Next Due date 19-03-2020
Next due premium (Rs.) 50000.00 Death Sum Assured 500000.00

Tax Sections## Amount (Rs.)

80 C of Income Tax Act, 1961* 51000.00
80 CCC of Income Tax Act, 1961** 0.00
80D of Income Tax Act, 1961*** 0.00
Total Premium 51000.00
Goods and Service Tax 2295.00
#Total amount paid during the Financial Year 2018-2019 : 53295.00
Total amount of Top up premium paid during the Financial Year 2018-2019 : 0.00
Amount available in Excess: 0.00

Rider Details
Rider Name Rider Sum assured Rider Premium
Tata AIA Life Insu 500000.00 1000.00
rance Accidental D
eath and Dismember
ment (Long Scale)
(ADDL) Rider

* Includes Life Plans, Riders and Immediate Annuity products.

** Includes Pension Plans. Tax benefit is 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 is not available for premium payment in cash or through automatic loans from Cash Value of the policy if any, as per the policy
provisions.
# Subject to realization of payment received.
^ Annualised Premium shall be the premium payable in a year with respect to the basic sum assured chosen by the policy holder,excluding the underwriting extra premiums and loading for
modal premiums, if any.
All applicable taxes, duties, surcharge, cesses or levies, as may be imposed by Government, any statutory or administrative authority from time to time, on the premiums payable and benefits
secured under Policy, shall be borne and paid by the Policyholder.

## Income Tax benefits u/s 80C and 10(10D) would be available as per the prevailing income tax laws, subject to fulfillment of conditions stipulated therein. Tata AIA Life Insurance Company
Ltd. does not assume responsibility on tax implication mentioned anywhere in this document. Please consult your own tax consultant to know the tax benefits available to you.

IRDA has mandated for all payouts to be made through NEFT. Please register for NEFT, in case you have not done it already
This is a computer generated statement and does not require signature.

PAN: AABCT3784C
Category of Service: Life Insurance Service and / or Management of investment under ULIP Services

BEWARE OF SPURIOUS PHONE CALLS AND FICITIOUS/FRADULENT OFFERS:

IRDA of India clarifies to public that IRDA of India or its officials do not involve in activities like sale of any kind of insurance or financial products nor invest premiums.
IRDA of India does not announce any bonus. Public receiving such phone calls are requested to lodge a police complaint along with details of phone call, number.

Tata AIA Life Insurance Company Ltd. (IRDA of India Regn. No. 110)(CIN - U66010MH2000PLC128403)
Regd. & Corporate office: 14th Floor, Tower A, Peninsula Business Park, Senapati Bapat Marg, Lower Parel, Mumbai-400 013 .
Please contact us at 1860-266-9966 (local charges apply) or write to us at customercare@tataaia.com or SMS ‘SERVICE’ to 58888
L&C/Misc/2017/Jun/214