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B.

Medical Insurance
Policy No. & date Premium
paid from
1.4.12
Premium
payable
before
31.3.13
Total Less : Surrender of
policy in case of
annuity plan/bonus
recoered
Total
D. Unit Linked Insurance Plan/LIC
Policy No. Name of assured Sum
assured
Premium
payable
from 1.4.12
to date
Premium
payable
before
31.3.13
Total

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