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Kotak Gokul

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07-11-2020

Premium Certificate
Financial Year 2020-2021
To whomsoever it may concern

Gokul Pillai
F-301, Raj Estate,
Kashigaon, Miraroad,
Maharashtra
Thane
Pin: 401107
Phone1:
Phone2:

Client ID: 78693821

This is to confirm that we have received premium(s) from the above named Policy holder under the Policy No (s) as per details given
below

Policy No: 04362421

Cess, as
Plan Component Premium(A) S.Tax/GST(B)* applicable(C)*

Kotak Smart Advantage (UIN-107L042V01) 144500 - -

Premiums are eligible for tax deduction under Section 80C/80CCC of Income Tax Act, 1961. Tax laws are subject to change from
time to time. Please consult your tax advisor for implications.

Additional Premium due for Financial Year 2019-2020

Policy Plan Component Premium Due Premium Due Date Frequency

Kotak Smart Advantage


04362421 12125 25-Jan-2021 Monthly
(UIN-107L042V01)
Kotak Smart Advantage
04362421 12125 26-Feb-2021 Monthly
(UIN-107L042V01)
Kotak Smart Advantage
04362421 12125 26-Mar-2021 Monthly
(UIN-107L042V01)

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07-11-2020
Notes:

1 Goods and Services Tax and Cess, as applicable is levied at the tax rates in force which is subject to changes from time to
time.
2 Goods and Services Tax category: Life Insurance Services and Management of Investment under ULIP Services.
3 Goods and Services tax is applicable from 1st July' 2020.
4 This is a computer generated advice and does not require any signature.
5 In order to abide by the Foreign Account Tax Compliance Act (FATCA), kindly submit Insurance FATCA Declaration,
separately, if the answer to any of these questions is a `yes': (i) Are you a citizen of any other country apart from India (dual
or multiple citizenship); (ii) Are you a resident (for tax purposes) of any other country other than India; (iii) Do you hold a
green card of USA or any similar card for any other country?
It is mandatory for you to report any future changes in your tax status to Kotak Life Insurance within 30 days of such change.
Until we receive a written intimation about any such change, we shall presume that there is no change in your tax residency
status and consider your earlier submitted declarations, if any, as valid. For any queries about your tax residency, please contact
your tax advisor.

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07-11-2020

Premium Payment History

Policy No Receipt No Paid Date Paid Amount Frequency

04362421 AY148791 6-Dec-2020 12125 MONTHLY

04362421 AY392392 6-Nov-2020 12125 MONTHLY

04362421 AY231028 7-Oct-2020 12125 MONTHLY

04362421 AX237471 6-Sep-2020 12125 MONTHLY

04362421 AX095517 6-Aug-2020 12125 MONTHLY

04362421 AX986231 6-Jul-2020 12125 MONTHLY

04362421 AX537673 6-Jun-2020 12125 MONTHLY

04362421 AX168482 6-May-2020 12125 MONTHLY

04362421 AX385812 6-April-2029 12125 MONTHLY

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