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Aviva Life Insurance Company India Ltd.

Head Office: Aviva Tower, Sector Road, Opp Golf Course,DLF - Phase V
Sector - 43, Gurgaon - 122003 Tel: +91 (0) 124 2709046 Fax: +91 (0) 124 2571210

Mr. Satish Hindurao Dongale 26-Aug-10


AT. Ghotawade Post - Kaulav, UIN : 122L053V01
Tal-Radhanagari, Kolhapur
Kolhapur - 416211
Maharashtra
02321 241482
ÌALS1Çtz:ÈÂ26-Aug-Ç4*ÂÎ

Policy Account Statement - ALS1849026 as on 26-Aug-2010

Policy Owner : Mr. Satish Hindurao Dongale Policy Term : 20

Life Insured : Satish Hindurao Dongale Premium Frequency : Quarterly

Premium Amount (Rs.) *** : 3750.00

Commencement Date : 31-January-2008 Riders( s ) * : ADD

Sum Assured* : 450,000.00

Nominees : N/A

Unit account statement as on : 26-Aug-2010

Fund(s) No. of Units Unit Price(Rs.) Policy Fund Value (Rs.)

Growth Fund ULIP 783.32 33.07 25902

Total Fund Value ** : 25902

Details of premium received since 31-January-2009 :

Date Transaction Type Premium Received (Rs.)


31-January-2009 Regular Premium 3,750.00
18-May-2009 Regular Premium 3,750.00
10-August-2009 Regular Premium 3,750.00
03-November-2009 Regular Premium 3,750.00
03-February-2010 Regular Premium 3,750.00
30-April-2010 Regular Premium 3,750.00
10-August-2010 Regular Premium 3,750.00

Total premium received : 26,250.00

* Death and ADD/ CIPTD Rider benefits as per Policy Term and Conditions .
** The value of units depends on unit prices, which subject to change. The cash value of units are subject to surrender
penalty as per the policy terms and conditions.
*** Premium Inclusive of Service Tax w.e.f. 1st Jan 2006.
This is Computer generated statement, hence does not require signature.
Should you have any further queries, please contact our Customers Services Group at 1800-180-2266/0124-2709046

A Joint Venture between Dabur And Aviva


Aviva Life Insurance Company Ltd. Registered Office: 2nd Floor Prakashdeep Building 7 Tolstoy Marg New Delhi-110001 India

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