Bajaj Allianz Life Insurance

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Bajaj Allianz Life Insurance Co. Ltd.

Certificate For Premium Paid


(01-Apr-2021 to 31-Mar-2022)

Date: 31/10/2021

This is to certify that the premium under the following policies taken by the policy holder MR Mirza Abed Ali Baig has been received by Bajaj Allianz Life Insurance
Company Limited during the financial year 2019-2020.

Policy No Product Premium Due Sum Assured Premium Premium Life Insurance Health Care Service Financial Year
Date Adjustment Amount Premium(1) Premium(2) Tax/GST
Date Received Including cess

0343444544 GOAL_ASSUR 12/APR/2021 1800000 15/04/21 15000 15000 0 0 2021-22


E
12/MAY/2021 2021-22
0343444544 GOAL_ASSUR 1800000 14/05/21 15000 15000 0 0
E
GOAL_ASSUR 12/JUN/2021 1800000 13/06/21 15000 15000 0 0 2021-22
0343444544
E
2021-22
0343444544 GOAL_ASSUR 12/JUL/2021 1800000 15/07/21 15000 15000 0 0
E
GOAL_ASSUR 12/AUG/2021 1800000 14/08/21 15000 15000 0 0 2021-22
0343444544
E
2021-22
0343444544 GOAL_ASSUR 12/SEP/2021 1800000 13/09/21 15000 15000 0 0
E
GOAL_ASSUR 12/OCT/2021 1800000 17/10/21 15000 15000 0 0 2021-22
0343444544
E
2021-22
0343444544 GOAL_ASSUR 12/NOV/2021 1800000 13/11/21 15000 15000 0 0
E
GOAL_ASSUR 12/DEC/2021 1800000 10/12/21 15000 15000 0 0 2021-22
0343444544
E
2021-22
0343444544 GOAL_ASSUR 12/JAN/2022 1800000 16/01/22 15000 15000 0 0
E
Total : 150000.0 150000.0 0.0 0.0

Note:
Receipts issued subject to realization of cheques.
(1) Life Insurance Premium is eligible for tax rebate/deduction under Section 80C.
(2) HCB/C1/Post Hospitalization/Surgical Benefit Rider Premium is eligible for tax rebate/deduction under Section 80D..

* Single Premium Policies with cover less than 5 times the premium paid will not be eligible for tax deduction under section 80C. This
certificate is issued for the purpose of claiming deductions, rebates as per the provisions of Income Tax Act, 1961.
For your actual eligibility please refer to provisions of IT Act 1961 as modified and consult your tax consultant.

Tax will be deducted under section 194DA of the Income Tax Act, 1961 subject to conditions as mentioned in Section 10(10D) of Income Tax Act,1961.If PAN is
updated in system, TDS will be deducted @ 5% on income from policy.In the absence of PAN, TDS will be deducted @ 20% on income from policy. TDS once
deducted will not be refunded.Please update your PAN in system so that TDS certificate can be issued. In the absence of PAN, TDS certificate cannot be issued.

Please consult your Income Tax advisor/consultant for tax treatment under Income Tax Act,1961.

For NRI customers TDS shall be deducted under section 195 of Income Tax Act,1961 at applicable rates.

Note: This is a computer-generated letter and does not required a signature.

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