STATEMENT OF ACCOUNT AS ON 10/04/24

CAPITAL_UNIT_GAIN
To, Statement Date : 10-04-2024
Policy No. : 0035747845
Mr. SWARUPANANDA MOHANTY Issued Date : 23-JAN-07
Sum Assured : Rs. 200000
Frequency Of Payment : Yearly
Premium Amount : Rs. 10000
Policy is eligible for partial withdrawal post lock-in period
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
ACCELERATOR MID-CAP FUND :
127.4385 0 0 2522.941 321519.81 298.6923
ULIF03124/07/06ACCEMIDCAP116
0 0 2522.9409 321519.81 298.69

*Account Value Rs. 321519.81

ACCELERATOR MID-CAP FUND SFIN : ULIF03124/07/06ACCEMIDCAP116

Net
Transaction Allocation Allocated
Req ID Transaction Amount (Rs) Investment Unit Price
Date Rate % Units
(Rs)
New Business Regular(Capital
21-JAN-07 10000 95 3626.34 13.401 708.9023
Units)
21-JAN-08 Regular Premium Renewal Year 10000 95 9500 15.305 620.7122
21-JAN-09 Regular Premium Renewal Year 10000 95 9500 8.203 1158.1129
21-JAN-10 Regular Premium Renewal Year 10000 95 9500 19.2492 493.5270
21-JAN-11 Regular Premium Renewal Year 10000 95 9500 21.5883 440.0532
21-JAN-12 Regular Premium Renewal Year 10000 95 9500 18.8568 503.7970
21-JAN-12 Regular Premium Renewal Year 10000 95 9500 19.8493 478.6063
21-JAN-13 Regular Premium Renewal Year 10000 95 9500 22.9829 413.3508
21-JAN-14 Regular Premium Renewal Year 10000 95 9500 21.6712 438.3698
25-Apr-14 Partial Withdrawal Regular -70000 0 -70000 24.9953 -2800.5266
21-JAN-15 Regular Premium Renewal Year 10000 95 9500 37.7072 251.9413
21-JAN-16 Regular Premium Renewal Year 10000 95 9500 36.0307 263.6640
21-JAN-17 Regular Premium Renewal Year 10000 95 9500 47.2622 201.0063
21-JAN-18 Regular Premium Renewal Year 10000 95 9500 64.3164 147.7073
21-JAN-19 Regular Premium Renewal Year 10000 95 9500 54.658 173.8080
21-JAN-20 Regular Premium Renewal Year 10000 95 9500 54.7009 173.6717
21-JAN-21 Regular Premium Renewal Year 10000 95 9500 63.6474 149.2598
21-JAN-22 Regular Premium Renewal Year 10000 95 9500 79.916 118.8748
21-JAN-23 Regular Premium Renewal Year 10000 95 9500 86.3455 110.0231
21-JAN-24 Regular Premium Renewal Year 10000 95 9500 123.2053 77.1071
01-FEB-12 CDA Renewal Premium 9828.83 0 -9828.83 19.5095 -503.7971
Total Charges 0 0 -21142.33 0 -1095.2303
Balance c/f 2522.9409

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

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.
 Partial Withdrawals and Fund Switch are allowed only from Accumulation Units as per terms and conditions of
the policy ,

Accumulation Units 2494.85 & Unit Value is 317940.06 as on 10/04/24

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

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: [email protected] | 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
0054329626 12-JAN-07 CSH FRP 10000 C B372
UTI BANK
0119058962 16-JAN-08 CHQ RWP 10000 7479 16-JAN-08 T B372
LTD
AXIS BANK
0200615401 22-JAN-09 CHQ RWP 10000 73369 22-JAN-09 T B372
LTD.
0283955101 16-JAN-10 CSH RWP 10000 C B372
AXIS BANK
0363229388 21-JAN-11 CHQ RWP 10000 147502 21-JAN-11 T B372
LTD.
AXIS BANK
0433050821 28-JAN-12 CHQ RWP 10000 147504 28-JAN-12 R B372
LTD.
0434375077 03-FEB-12 CSH RWP 10100 C B372
0492720358 19-JAN-13 CSH CDA 100 C B372
0492721204 19-JAN-13 CSH RWP 10000 C B372
0543118445 21-JAN-14 CSH RWP 10000 C B4832
0587181884 21-JAN-15 CSH RWP 10000 C B4832
0633193263 25-JAN-16 CSH RWP 10000 C B5355

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.
 BS
Receipt Transaction Drawee Cheque Deposit
Receipt No. Pay Mode Amount Cheque No Cheque
Date Type Bank Date Bank
Status
0665571734 31-JAN-17 CSH RWP 10000 C B5285
0701683452 30-JAN-18 CSH RWP 10000 C B5355
0741273593 18-JAN-19 CSH RWP 10000 C B5285
0808365631 11-FEB-20 CSH RWP 10000 C B5285
0887252044 21-JAN-21 WALLET RWP 10000 T PAYU
0996419917 18-FEB-22 UPI RWP 10000 TECH T TECH
1094750213 08-FEB-23 UPI RWP 10000 TECH T TECH
1214688485 17-FEB-24 CCOL RWP 10000 T CITRUS

Assuring you the best of our services, always!

Your Life Goals enabler,
Bajaj Allianz Life

For any assistance

Call our Toll Free Number: 18002097272 Email us on: [email protected]

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.