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Mon Jan 13 17 - 05 - 27 GMT+05 - 30 2025 - 33854300202400 - Tax - Receipt

This document is a premium receipt for Mrs. Nibedita Mohanty's health insurance policy ReAssure 2.0, with a policy number of 33854300202400. The total gross premium received is Rs. 3,662.00, covering a family floater plan with a base sum insured of Rs. 5,00,000, valid from 12/03/2024 to 11/03/2025. The receipt also includes details of the insured individuals and tax deduction information under section 80D of the Income Tax Act.

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5 views1 page

Mon Jan 13 17 - 05 - 27 GMT+05 - 30 2025 - 33854300202400 - Tax - Receipt

This document is a premium receipt for Mrs. Nibedita Mohanty's health insurance policy ReAssure 2.0, with a policy number of 33854300202400. The total gross premium received is Rs. 3,662.00, covering a family floater plan with a base sum insured of Rs. 5,00,000, valid from 12/03/2024 to 11/03/2025. The receipt also includes details of the insured individuals and tax deduction information under section 80D of the Income Tax Act.

Uploaded by

Shreya
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Premium Receipt - ReAssure 2.

0
Dear MRS. NIBEDITA MOHANTY
11-A 3RD FLOOR HAUZ RANI MALVIYA NAGAR SOUTH DELHI
-
DELHI - 110017

We acknowledge the receipt of payment towards the premium of the following health insurance policy:

Policyholder Name Mrs. Nibedita Mohanty Policy Number 33854300202400

Product Name ReAssure 2.0 Plan Opted Family Floater Base Sum Insured 5,00,000

Policy Commencement Date # 12/03/2024 Policy Expiry Date 11/03/2025

Premium Calculation for Installment period 12/12/2024 to 11/01/2025

Premium (Rs.) - Base Product 2,840.00

Premium (Rs.) - Safeguard+ 426.00

Underwriting Loading (Rs.) 0.00

Digital Discount 163.00

Net Premium / Taxable value (Rs.) 3,103.00

Integrated Goods and Service Tax (18.00 %) 0.00

Central Goods and Service Tax (9.00 %) 279.27

State/UT Goods and Service Tax (9.00 %) 279.27

Gross Premium (Rs.) 3,662.00

Total Premium Received till the current installment (Rs.) 36,620.00


#
Issuance of policy is subject to clearance of premium paid

Details of persons Insured:


Name of Person Insured Age Gender Relationship**

Ms. Nibedita Mohanty 48 Female Applicant

Mr. Ravi Sankar Mohanty 51 Male Spouse

Ms. Shreya Mohanty 19 Female Daughter

Ms. Shruti Mohanty 17 Female Daughter

For the purpose of deduction under section 80D, the benefit shall be as per the provisions of the Income Tax Act,1961 and any amendments made
thereafter. For your eligibility and deductions, please refer to provisions of Income Tax Act 1961 as modified and consult your tax consultant. In the
event of non-realization of premium, tax benefits cannot be obtained against this premium receipt.

Upon issuance of this receipt, all previously issued temporary receipts, if any, related to this policy are considered null and void.

GSTI No.: 07AAFCM7916H1ZA SAC Code / Type of Service : 997133 / General Insurance Services

Niva Bupa State Code: 7 Customer State Code / Customer GSTI No.: 7 /NA

Location: New Delhi Director - Operations & Customer Service


Date: 13/12/2024 For and on behalf of Niva Bupa Health Insurance Company Limited
(formerly known as Max Bupa Health Insurance Co. Ltd.)

Product Name: ReAssure 2.0 | Product UIN: NBHHLIP23169V012223

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