Premium Receipt
Dear MR. KATTA SRINIVASACHARYULU
8-166/A, BALAJI CONVENT STREET,
MUMMIDIVARAM, EAST GODAVARI
ANDHRA PRADESH - 533216
We acknowledge the receipt of payment towards the premium of the following health insurance policy:
Policyholder Name Mr. KATTA SRINIVASACHARYULU Policy Number 32965074201968
Product Name ReAssure Plan Opted Individual Base Sum Insured 7,50,000
Policy Commencement Date # 05/05/2023 Policy Expiry Date 04/05/2025
Premium Calculation:
(A) Premium (Rs.) - Base Product 18,656.00
(B) Premium (Rs.) - Personal Accident Cover 0.00
(C) Premium (Rs.) - Safeguard 0.00
(D) Premium (Rs.) - Hospital Cash 0.00
(E) Premium (Rs.) - Smart Health+: Disease Management Add-on 4,576.00
Underwriting Loading (Rs.) 0.00
Total Discount (Rs.) 0.00
Net Premium / Taxable value (Rs.) 23,232.00
Integrated Goods and Service Tax (18.00 %) 4,181.76
Central Goods and Service Tax (0.00 %) 0.00
State/UT Goods and Service Tax (0.00 %) 0.00
Gross Premium (Rs.) 27,414.00
#Issuance of policy is subject to clearance of premium paid
Details of Persons Insured
Name of person Insured Age Insured Taxable Benefit Premium* Gender Relationship**
Mr. KATTA SRINIVASACHARYULU 55 27,414.00 Male Father
*Amount includes taxes applied on a member basis. Any mismatch in the total summation of premium of each member from the gross premium is
the result of rounding.
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 the 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.
Product Name: ReAssure | Product UIN: NBHHLIP23107V022223, Add On Name: Smart Health+ | Add On UIN: NBHHLIA22164V012122
