PREMIUM RECEIPT
Tax Invoice
Receipt No.: 1000000044698 Receipt Date : 17-Mar-2025
Personal Details
Unique Invoice Number
Application No.: 6119126267 Policy No.:
Policy Holder’s Name: SUBODH DEBBARMA PAN No.: BLNPD3277R
E-mail: [email protected] Contact No.: 9436109532
Policy Details
Plan Name: Bajaj Allianz Life Goal Suraksha
Life Insured: MARTIN DEBBARMA
Sum Assured: 250000 Policy Commencement Date: 17-Mar-2025
Policy Term: 12 Premium Payment Term: 7
Premium (W/O GST): 26125.0 Premium Payment Frequency: ANNUAL
Premium Due Date From: 17-Mar-2025 Premium Due Date To: 17-Mar-2026
Premium Received (incl GST): 26125 Next Due Date: 17-Mar-2026
Amount in Words: Twenty Six Thousand Rupees One Hundred Rupees Twenty Five
Agent Code: 11SO015191 Agent Name: Mani Naha
Tax Details
GSTIN of the Customer in case having GST registration
GSTIN of Supplier BALIC source branch. UIN Code: 116N155V13
Description of Services Insurance HSN Code:
Whether GST is payable under Reverse Charge on such supplies.
State Name and code in case of inter-state supply Maharashtra
Policy No Product Name Taxable Value CGST 9% SGST/UTGST 9% IGST 18% TOTAL
Bajaj Allianz Life Goal
26125.00
Suraksha
Disclaimer:Insurance cover shall commence only from the date of acceptance of risk, based on proposal papers submitted and other requirements called for. In case of
reinstatement of policy, insurance cover shall resume from the date of reinstatement. In case of outstation cheque, NAV will be as per the unit price of the date of
realization of the cheque.
For eligibility under section 80C/80D of income Tax Act,1961. Please consult your tax advisor.
Experience convenience at your fingertips with Bajaj Allianz Life – Life Assist, our comprehensive customer portal and mobile
application to:
Update contact & Check Fund Switch Funds To access app,
bank details Performance scan QR code
Register for Autopay/ Pay Premium Download e-Statement
Auto-Debit & Top-ups & e-Policy Bond
Premium Receipt is subject to realization of negotiable instrument / Bankers instruction. Mudrank No.:
This is system generated receipt hence requires no signature.
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BEWARE OF SPURIOUS PHONE CALLS AND FICTITIOUS / FRAUDULENT OFFERS! IRDAI is not involved in activities like selling insurance policies, announcing bonus or investment of premiums. Public receiving such phone calls are
requested to lodge a police complaint.
Bajaj Allianz Life Insurance Co. Ltd., Regd. Office Address: Bajaj Allianz House, Airport Road, Yerawada, Pune - 411006., IRDAI Reg No.: 116, Visit : www.bajajallianzlife.com, CIN :
U66010PN2001PLC015959, Mail us : [email protected], Call on : Toll free no. 1800 209 7272, Fax No: 02066026789. The Logo of Bajaj Allianz Life Insurance Co. Ltd. is provided on
the basis of license given by Bajaj Finserv Ltd. to use its “Bajaj” Logo and Allianz SE to use its “Allianz” logo.
