Dear Ms.

Anamika Choudhary ,
House No 917/3
Sector 9
Old Vijay Nagar
Ghaziabad
Uttar Pradesh - 201001
Thank you for being part of the Max Bupa Family. This is to certify that we have received a premium from you for
the period 18/06/2015 to 17/06/2016 as per details below:

Policy Holders
Name
Plan Opted for

Ms. Anamika Choudhary

Commencement
Date

18/06/2015

Heartbeat Gold 05 Lacs 1A

Net Premium(Rs.)
Service Tax(Rs.)
Education Cess (Rs.)
Secondary & Higher Education Cess (Rs.)
Gross Premium (Rs.)

Policy
Number
Sum
Insured (Rs)
Expiry date

30435998201500
500000
17/06/2016

7275.00
1019.00
0.00
0.00
8294.00

We also take this opportunity to reiterate that we value your patronage and are committed to providing you the
best in class service.
For & On behalf of Max Bupa Health Insurance Co. Ltd.

Somesh Chandra
Chief Operations Officer & Chief Quality Officer
Note :
1.
2.
3.

Location: New Delhi

Date: 11/02/2016

The total premium amount is inclusive of Service Tax if paid.

This is a certificate of premium paid and may be used for the purposes of claiming deduction under
Section 80D of the Income Tax Act, 1961.
This statement is in addition to the premium receipt sent to you and shall not be considered as a premium
receipt.