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IRDAI No : 128

PREMIUM PAID CERTIFICATE FOR THE YEAR 2017 - 2018

Mr/Ms/Mrs INDIRA SRINIVASAN Date: 30/01/2019


NO 2, SUNDARESAN 1 ST CROSS STREET,
RAJAJI NAGAR,
PALLAVARAM
KANCHIPURAM
KANCHIPURAM - 600043
TAMIL NADU
India
Contact No: 9444906050

This is to certify that the following Premium Payments have been made under life insurance policies

held by Mr/Ms/Mrs INDIRA SRINIVASAN

During the financial year from 01/04/2017 to 31/03/2018

Sl.No Policy Number Life Assured Name Premium Inst. GST Total Mode Plan Term Sum Assured
Paid Date Prem. Premium
1 NN011712057476 INDIRA SRINIVASAN 14/12/2017 47588 2221.00 49809.00 Yearly SHRIRAM 10 470000
LIFE
ASSURED
INCOME
PLAN

TOTAL PREMIUM PAID 49809.00 /- (Rupees Forty Nine Thousand Eight Hundred And Nine Only)

Eligible for Deduction under Section 80C, of the Income Tax Act subject to the conditions specified therein.

AUTHORISED
SIGNATORY

Mr.L.Venkatesh

Division: CHENNAI DO Branch: Coimbatore Gandhi Puram

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