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PREMIUM PAID CERTIFICATE FOR THE YEAR 2014-2015

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Date: 11/8/<strong>2014</strong><br />

Mr. RAMAMURTHY PATHURI<br />

<strong>PREMIUM</strong> <strong>PAID</strong> <strong>CERTIFICATE</strong> <strong>FOR</strong> <strong>THE</strong> <strong>YEAR</strong> <strong>2014</strong>-<strong>2015</strong><br />

This is to certify that as per our records the following payments have been received by us to effect or<br />

keep "In Force" Life Insurance Policies held by<br />

Mr. RAMAMURTHY PATHURI<br />

Life Assured's Name: RAMAMURTHY, PATHURI<br />

Policy No.: 15238442<br />

Plan Name: ICICI Pru iProtect Option II<br />

Benefits/Rider Sum Assured Coverage Premium Amount Premium Due UIN<br />

ICICI Pru iProtect Option II 10,000,000.00 SEC 80 C 33,146.00 0.00 105N110V01<br />

Policy Total 33,146.00<br />

Premium Paid in<br />

Advance<br />

0.00<br />

Total Premium 33,146.00<br />

Premium Due 0.00<br />

Premium Paid to avail Income Tax Benefits Under:<br />

SEC 80 CCC(1) 0.00<br />

SEC 80 C 33,146.00<br />

SEC 80 D 0.00<br />

0.00<br />

Total 33,146.00<br />

Please note the mortality charges under the base plan as well as riders (if any) would be recovered every<br />

month as per the Terms and Conditions of the Policy.<br />

The above mortality charges are the actual charges recovered till date. The recovery of such charges would<br />

be subject to change on monthly basis.<br />

This is a computer generated statement and does not require any signature.<br />

ICICI Prudential Life Insurance Company Limited.<br />

Communication Address:Vinod Silk Mills Compound,Chakravarthy Ashok Road, Ashok Nagar,Kandivali(E), Mumbai-400 101<br />

Registered Office:ICICI Prulife Towers,1089, Appasaheb Marathe Marg,Prabhadevi,Mumbai-400 025<br />

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