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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 CERTIFICATE FOR THE YEAR 2013-2014 DATE OF ISSUE: 28/12/2013

This is to certify that the following premium have been received under the following life insurance policy held by Bobhate Sandeep Gajanan
Name Policy Number Plan Policy Term Premium Paying Term Commencement Date Instalment Premium Mode Of Premium Payment Reference Code Bobhate Sandeep Gajanan 882896013 75(The Money Back Policy - 20 Years) 20 20 27/01/2007 826.00 QLY 88757043

Due From

Due To

Number Of Instalments

Premium Amount Received 1,652.00 826.00 826.00

Received Date

Collecting Branch

Status Normal Normal Normal

01/2013 04/2013 2 07/2013 07/2013 1 10/2013 10/2013 1

05/04/2013 91R 26/08/2013 91R 19/11/2013 91R

Total amount received towards premium for the policy number 882896013 is Rs. 3,304.00 for the financial year 2013-2014

This certificate is electronically generated

https://customer.onlinelic.in/LICEPS/appmanager/Generic/TaxCertificateHome?selectedValues=mom81x| 882896013| 2013|

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