APGLI MISSING CREDITS PROFORMA

NAME OF THE EMPLOYEE & DESIGNATION :

POLICY NUMBER:

NAME OF THE MONTH

AND YEAR POLICY
AMOUNT MISSING

STARTING TO END

LP

L2012110_A
MPUP SCHOOL NARASAPURAM
GUDLUR MANDALAM , PRAKASAM DT.

PRESENT PLACE OF WORKING:

S.NO.

CH SAILAJA

MONTLY SUBSCRIPTION
DEDUCTED IN THE
MONTH

Jun-13

TOTAL AMOUNT OF THE

SCHEDULE

TRANSACTION ID NUMBER
AND DATE

REMARKS

ONLY ADDED ONE MONTH

SIGNATURE OF THE
HEAD OF THE OFFICER

DDED ONE MONTH