STATEMENT OF ACCOUNT AS ON 24/11/24

LONGLIFE_GOAL
To, Statement Date : 24-11-2024
Policy No. : 0481453702
Mr. HEMANT KHETAN Issued Date : 29-OCT-21
Sum Assured : Rs. 500000
Frequency Of Payment : Half yearly
Premium Amount : Rs. 25000
Policy is eligible for partial withdrawal post lock-in period
Portfolio Strategy : Investor selectable portfolio strategy

Summary Top Up
Top Up
Regular
Regular
Fund Name & SFIN NAV Premium Premium Fund Capital Units
Premium Units Premium Units
Fund Value Value
PURE STOCK FUND II :
26.2359 0 0 8300.054 217759.38 0
ULIF07709/01/2017PURSTKFUN2116
0 0 8300.0537 217759.38 0

*Account Value Rs. 217759.38

Net
Transaction Allocation Allocated
Req ID Transaction Amount (Rs) Investment Unit Price
Date Rate % Units
(Rs)
29-OCT-21 New Business Regular 50000 94 47000 17.3288 2712.2478
27-OCT-22 Regular Premium Renewal Year 25000 94 23500 17.3552 1354.0610
28-Apr-23 Regular Premium Renewal Year 25000 94 23500 17.4023 1350.3962
28-Apr-23 Unit Adjustment Invest Regular 0 0 183.32 17.4023 10.5341
30-OCT-23 Regular Premium Renewal Year 25000 94 23500 19.7291 1191.1339
Unit Adjustment Withdrawal
30-OCT-23 0 0 -2.5 19.7291 -0.1268
Regular
29-Apr-24 Regular Premium Renewal Year 25000 94 23500 24.2488 969.1201
28-OCT-24 Regular Premium Renewal Year 25000 94 23500 26.9056 873.4241
Total Charges 0 0 -3076.65 0 -160.7368
Balance c/f 8300.0537

Foreclosure Pen in Rs : 0 ST/GST on Pen in Rs : 0

Partial Withdrawals and Fund Switch are allowed only from Accumulation Units as per terms and conditions of
the policy ,
Accumulation Units 0 & Unit Value is 0 as on
Lock- In Period
Withdrawal 5 Years from date of commencement
Surrender 5 Years from date of commencement
Top Up 5 Years from date of Top Up adjustment

*The Account Value on the basis of which your request shall be processed may be subject to revision at the time of final
verification of the Statement of Account. The Company reserves the right to make necessary corrections in the Statement of
Account to remove any inadvertent errors and prepare the same in accordance with Policy Terms

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 : customercare@bajajallianz.co.in, 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.
 Disclaimer :
Tax will be deducted under section 194DA of the Income Tax Act, 1961 subject to conditions as mentioned in Section 10(10D)
of Income Tax Act,1961.If PAN is updated in system, TDS will be deducted @ 5% on income from policy. In the absence of PAN,
TDS will be deducted @ 20% on income from policy. TDS once deducted will not be refunded.
1. Please update your PAN in system so that TDS certificate can be issued. In the absence of PAN, TDS certificate cannot be
issued. Please consult your Income Tax advisor/consultant for tax treatment under Income Tax Act,1961.
For NRI customers TDS shall be deducted under section 195 of Income Tax Act,1961 at applicable rates.
2. You have the option to receive the claims/maturity payments/other sum due to you from the Company through electronic
mode. If you wish to receive the payment through electronic mode, kindly furnish your Bank Account details (Account No,
Name & Address of the Bank and IFSC No.) along with a copy of cancelled cheque at the Office of the Company.
Please ensure to keep your bank particulars updated in case of any subsequent change.
* Account Value is based on NAV available on
Service tax or Goods and service tax is charged as applicable
Note : This is a computer generated letter. No signature is required.
Regd. Office Address: Bajaj Allianz House, Airport Road, Yerawada, Pune - 411006. Reg. No.: 116. CIN :
U66010PN2001PLC015959 | Mail us: customercare@bajajallianzlife.co.in | Call on : Toll free no. 1800 209 7272 | Fax No:
02066026789.

Collection Details
BS
Receipt Transaction Drawee Cheque Deposit
Receipt No. Pay Mode Amount Cheque No Cheque
Date Type Bank Date Bank
Status
0964612496 25-OCT-21 SGR FRP 50000 T
1062859110 16-OCT-22 CCOL RWP 25000 CITRUS T CITRUS
1118083040 27-Apr-23 NACH RWP 25000 T B5402
1168206476 27-OCT-23 NACH RWP 25000 T B5402
1244787776 27-Apr-24 NACH RWP 25000 T B5402
1308067944 27-OCT-24 NACH RWP 25000 T B5402

Assuring you the best of our services, always!

For any assistance

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 : customercare@bajajallianz.co.in, 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.