Nil
Original Receipt

To,

ICICI Prudential Life Insurance Company Limited,

Policy No- 01277605 dated 05.01.2005.

Dear Sir,

With reference to my policy I have been deposited. My last year premium dated on 12.06.2007 vide Receipt No- 244664. Till date I have not received any original receipt copy due to change of my residential address. So you may please be sent the documents / corresponds vide e-mail address/ new residential address as mention below.

Thanking you,

P. Maulik

New Residential Address:-

P. Maulik

240, Virat Nagar

Model Town, Panipat

Haryana-132 103