Date: 13/4/2018

Mr. Naveen Kumar L.

No.308, 3rd Floor
Nisarga Mansion
Dooda Thuguru
Bangalore
Karnataka
560100
PREMIUM PAID CERTIFICATE FOR THE YEAR 2018-2019

This is to certify that as per our records the following payments have been received by us to
effect or keep "In Force" Life Insurance Policies held by Mr. Naveen Kumar L.

Life Assured's Name: Naveen Kumar, L.

Policy No.: 05593924 Plan Name: LifeTime Super

Benefits/Rider Sum Assured Coverage Premium Amount Premium Due UIN

ICICI Pru LifeTime Super 8,00,000.00 SEC 80 C 96,000.00 0.00 105L056V01
Policy Total 96,000.00
Premium Paid
in 0.00
Advance
Total
Premium 96,000.00
Premium Due 0.00

Premium Paid to avail Income Tax Benefits Under:

SEC 80 CCC(1) 0.00

SEC 80 C 96,000.00
SEC 80 D 0.00
0.00

Total 96,000.00

Please note the mortality charges under the base plan as well as riders (if any) would be
recovered every month as per the Terms and Conditions of the Policy.

The above mortality charges are the actual charges recovered till date. The recovery of such
charges would be subject to change on monthly basis.

This is a computer generated statement and does not require any signature.

ICICI Prudential Life Insurance Company Limited.

Communication Address:Vinod Silk Mills Compound,Chakravarthy Ashok Road, Ashok Nagar,Kandivali(E), Mumbai-400 101
Registered Office:ICICI Prulife Towers,1089, Appasaheb Marathe Marg,Prabhadevi,Mumbai-400 025
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