7/11/2014 Premium Receipt

Premium Receipt

Life Assured: Srikanth Konde Date: 22/4/2014

Policy Holder Name: Srikanth Konde Policy No: 00769118

Address: Flat No 109 Sri Sadguru Krupa

Sadan Apartments
Beside C hanakya Public School
Vizanagaram
535003
Andhra Pradesh
IND

Date Of Commencement Frequency Of Payment Premium Due Date Premium Paid

22/4/2014 Yearly 22/4/2014 40000.00

Yours Sincerely,

Star Union Dai-ichi Life Insurance C o. Ltd.

Note:
1. Amount received by cheque is subject to realisation of cheque.
2. This is a computer generated receipt and hence do not require signature.
3. Eligible for Income Tax rebates as per rules.
4. Service Tax applicable as per prevailing service tax law.
C ategory : Life Insurance. Service tax registration no. AALC S3949OST001

Regd. Office: Star House 3rd Floor, (West Wing), C -5, 'G' Block, Bandra-Kurla C omplex, Bandra
(East), Mumbai-400051

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