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 2018-2019

DATE OF ISSUE :13/02/2019

The following premium has been received for life insurance policies Taniya Das

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 (`) (`)
428378975 14/04/2018 1 41B
14/07/2010 919.00 20.68 11/05/2018
Taniya Das 14/04/2018 Qly 41B

428378975 14/07/2018 2 EPS1

14/07/2010 1,838.00 -8.70 21/11/2018
Taniya Das 14/10/2018 Qly 41B

401990577 20/05/2018 1 41B

20/02/2018 1,227.00 55.22 18/05/2018
Taniya Das 20/05/2018 Qly 41B

401990577 20/08/2018 2 41B

20/02/2018 2,454.00 124.48 21/01/2019
Taniya Das 20/11/2018 Qly 41B

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

Total amount received towards premium for the policies listed above is ` 6,438.00 for the financial year 2018-
2019.

Total amount received towards Service Tax / GST for the policies listed above is ` 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.