Life Insurance Corporation of India PCMC, Network Operating Center 1st Floor, Jeevan Seva Annexe S.V.

Road, Santacruz(W) Mumbai - 400 054

PREMIUM PAID CERTIFICATE FOR THE YEAR 2011-2012 DATE OF ISSUE: 22/12/2011

This is to certify that the following premium have been received under the following life insurance policy held by Sagar Arun Kamble

Name Sagar Arun Kamble Policy Number 959563477 Plan 149(Jeevan Anand) 78

Policy Term

Premium Paying Term 25 Commencement Date 26/04/2011 Instalment Premium 3,363.00 MLY

Mode Of Premium Payment Reference Code 95421167

Due From Due To Number Of Instalments Premium Amount Received Collecting Branch Status

Received Date

05/2011 06/2011 07/2011 08/2011 09/2011 10/2011

05/2011 06/2011 07/2011 08/2011 09/2011 10/2011

1 1 1 1 1 1

3,363.00 3,363.00 3,363.00 3,363.00 3,363.00 3,363.00

28/05/2011 28/06/2011 28/07/2011 29/08/2011 28/09/2011 28/10/2011

D095 D095 D095 D095 B095 B095

Normal Normal Normal Normal Normal Normal

Total amount received towards premium for the policy number 959563477 is Rs. 20,178.00 for the financial year 2011-2012

This certificate is electronically generated