For the period 03 Jan 2011 to 20 Oct 2012 Mr. Upinder Pal Singh B 23/248 ..

Aslamabad Hoshiarpur Punjab 9216540668 upinderpalsingh@hotmail.com Premium Paid Premium Allocation Charges Net Charges
Transaction Date 03/01/2011 30/06/2012 Transaction Description Opening Balance Bonus Unit Allocation Policy Administration Charge Service Tax Education Cess Closing Balance

Policy Id Product Name Sum Assured Page No

00262555 LifeTime Pension 0.00 1 of 3

20000.00 Top-Up Premium 800.00 Top-Up Charges 800.00 Net Allocated Funds
Amount (Rs) 0.00 140.70 -149.30 -18.19 -0.54 0.00 NAV as on date 0.00 20.13270 0.00 0.00 0.00 0.00 Units

0.00
0.00 19200.00

Total Units 549.59136

TRANSACTION FOR PROTECTOR FUND

6.98878 -7.68596 -0.93507 -0.02776 547.93084

20/10/2012

Transaction Date 03/01/2011 06/01/2011 02/03/2012 30/06/2012

Transaction Description Opening Balance Allocated Premium Allocated Premium Bonus Unit Allocation Policy Administration Charge Service Tax Education Cess Closing Balance Transaction Description Opening Balance Bonus Unit Allocation Policy Administration Charge Service Tax Education Cess Closing Balance

Amount (Rs) 0.00 9600.00 9600.00 1557.83 -1545.67 -191.75 -5.75 0.00 Amount (Rs) 0.00 100.76 -104.31 -12.90 -0.39 0.00

NAV as on date 0.00 31.66000 31.61000 31.55000 0.00 0.00 0.00 0.00 NAV as on date 0.00 64.73000 0.00 0.00 0.00 0.00

Units

Total Units 3271.94813

TRANSACTIONS FOR BALANCER FUND

303.22173 303.70136 49.37647 -50.63208 -6.23985 -0.18712 3871.18865 Units Total Units 122.41570 1.55668 -1.71206 -0.20837 -0.00630 122.04580

20/10/2012 Transaction Date 03/01/2011 30/06/2012

TRANSACTION FOR MAXIMISER FUND

20/10/2012

For the period 03 Jan 2011 to 20 Oct 2012 Mr. Upinder Pal Singh B 23/248 .. Aslamabad Hoshiarpur Punjab 9216540668 upinderpalsingh@hotmail.com Premium Paid Premium Allocation Charges Net Charges
SUMMARY OF FUNDS Premium Allocation Charges Top-Up Charges Switch Charges Balancer SFIN Funds Allocated Switch In Switch Out CHARGES Policy Administration Charge Education Cess Service Tax Fund Value - Closing bal(in Rs.) Current NAV Closing balance (in units)
ULIF 005 03/05/02 PBalancer1 105

Policy Id Product Name Sum Assured Page No

00262555 LifeTime Pension 0.00 2 of 3

20000.00 Top-Up Premium 800.00 Top-Up Charges 800.00 Net Allocated Funds
800.00 0.00 0.00 Protector
ULIF 006 03/05/02 PProtect1 105

0.00
0.00 19200.00

Maximiser
ULIF 004 03/05/02 PMaximis1 105

19200.00 0.00 0.00 -1545.67 -5.75 -191.75 126278.17376 32.62000 3871.18865

0.00 0.00 0.00 -149.30 -0.54 -18.19 11431.59070 20.86320 547.93084

0.00 0.00 0.00 -104.31 -0.39 -12.90 8418.71928 68.98000 122.04580

For the period 03 Jan 2011 to 20 Oct 2012 Mr. Upinder Pal Singh B 23/248 .. Aslamabad Hoshiarpur Punjab 9216540668 upinderpalsingh@hotmail.com Premium Paid Premium Allocation Charges Net Charges Policy Id Product Name Sum Assured Page No 00262555 LifeTime Pension 0.00 3 of 3

20000.00 Top-Up Premium 800.00 Top-Up Charges 800.00 Net Allocated Funds

0.00
0.00 19200.00

* IN ULIP POLICIES, THE INVESTMENT RISK IN THE INVESTMENT PORTFOLIO IS BORNE BY THE POLICYHOLDER. The past performance of the Investment Funds is not indicative of their future performance. The names of the Investment Funds or of the Policy are not indicative of the returns that may be expected of them. * This is an authenticated statement which does not require any signature. In case of any discrepancies, please notify us immediately through any of our contact points. The unit statement shall be read in conjunction with the terms and conditions mentionedin the policy document. * Charges includes Mortality (Insurance) Charges, Policy Administration (Administration) & Fund Management Charges, Switching Charge, Partial Withdrawal Charge, Surrender Charge and any other charge as stated in the Policy Document. The Charges will berecovered in accordance with the Policy terms and conditions; by cancellation of units. * For ULIPs, applicability of NAV (a) Renewal premium received by way of a local cheque /pay order/ demand draft/ECS/ Credit Card/ Direct DebitNAV of the date of receipt of instrument at ICICIs Office or the premium due date, whichever is later. (b) In case of payment made to collection centre other than ICICIs Office or payment made by any other mode of payment apart from what is mentioned above, the date of intimation by the collection center to the Office or the premium due date, whichever is later. (c) Renewal payment received by way of outstation cheque/pay order/demand drafts NAV of the due date or the date of realizationof the amount by the company, whichever is later. (d) As per the current IRDA Guidelines w.e.f. June 1, 2007, the Cut off timing for NAV application in respect of allocation & redemption of the unit is 3.00 p.m. IST. For details refer to policy terms & conditions. * In the event of discontinuance of payment of premium, partwithdrawal or surrender of the policy, etc, benefits payable will be in accordance with the policy terms and conditions. The surrender value may be different from the Fund Value as mentioned in this statement. * The Fund Value may change as per the Net Asset Value (NAV)declared on a daily basis. The NAV is published in local newspapersand can be accessed on our website www.iciciprulife.com. * Tax benefits on premium paid under the Policy will be as per the provisions of the Income Tax Act, 1961. Tax laws are subject to amendment from time to time. * Service Tax details: Category of Service : Life Insurance and Management of Investment under ULIP; Service Tax Registration (STC) AAACI7351PST001. * Service Tax is calculated at 1.545% (1.50% Service Tax + 2% Education Cess on Service Tax + 1% Secondary and Higher Education Cess on Service Tax) for Traditional Endowment and Annuity Products and 10.30% (10% Service Tax + 2% Education Cess on Service Tax + 1% Secondary and Higher Education Cess on Service Tax) for ULIP, Pure Term and Health Products and Riders. * The policyholder shall be required to pay Service Tax, Education Cess or any other form of taxes or charges or levies as per prevailing laws and regulations, whichever applicable as perCompany's policy. * As stipulated by the Insurance and Regulatory DevelopmentAuthority (IRDA) in its circular dated July 29, 2011, the formula for computation of the Net Asset Value per Unit (NAV) for Linked funds stands modified. Old formula as prescribed by IRDA and as contained in the policy document: Market value of the investmentplus / (minus) expenses incurred in the purchase / (sale) of assetsplus current assets and accrued interest (net of fund management charges) less current liabilities and provisions, divided by, number of units outstanding under the fund at valuation date (beforecreation / redemption of units). Modified formula as stipulated by IRDA effective August 18, 2011: Market value of theinvestment held by the fund plus value of current assets less valueof current liabilities and provisions, if any and divided by the number of units existing on the valuation date (before creation/redemption of units) The policy document shall accordinglystand modified. Please note that there would be no impact on the number of units held on account of this change. * 2011, ICICI Prudential Life Insurance Company Limited. RegdAddress: ICICI Prulife Towers, 1089 Appasaheb Marathe Marg,Prabhadevi, Mumbai400025. Reg No: 105. Insurance is the subject matter of the solicitation. Comp/doc/July/2011/340.