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Life Insurance Corporation of India

PCMC,Network Operating Center


1st Floor,Jeevan Seva Annexe
S.V. Road,SantaCruz(W)
Mumbai - 400 054

PREMIUM PAID STATEMENT FOR THE YEAR 2018-19


DATE OF ISSUE :11/02/2019

The following premium has been received for life insurance policies of Vignesh D

Premium/ Service
Number of Tax / GST
Instalments Additional Received
Policy Number Date Of Due From Amount Coll. Br.
and Premium Date
Policy Holder's Name Commence. Due To Received * Serv. Br.
Payment Amount
mode (`) (`)
758197490 15/07/2018 1 EPS1
06/07/2015 50,265.00 1,130.96 16/07/2018
Vignesh D 15/07/2018 Hly 757

758197490 15/03/2019 1 EPS1


06/07/2015 50,265.00 1,130.96 11/02/2019
Vignesh D 15/03/2019 Hly 757

All the above payments are subject to cheque realisation, wherever applicable.

Total amount received towards premium for the policies listed above is ` 100,530.00 for the financial year
2018-2019.

Total amount received towards Service Tax / GST for the policies listed above is ` 2261.92 for the financial
year 2018-2019.

* Please note GST is applicable from 1st July, 2017.

This document is electronically generated. In case of any queries, please send SMS as follows -- type "LICHELP
<policy no>" and send it to 9222492224. Our Customerzone Official will get in touch with you shortly.

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