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1/10/12 TaxCertificateHome Life In ance Co po a ion of India PCMC, Ne o k Ope

Life In ance Co po a ion of India PCMC, Ne o k Ope a ing Cen e 1 Floo , Jee an Se a Anne e S.V.Road, San ac (W) M mbai ­ 400 054

PREMIUM PAID CERTIFICATE FOR THE YEAR 2011­2012 DATE OF ISSUE: 10/01/2012

Thi i o ce if ha he follo ing p emi m ha e been ecei ed nde he follo ing life in ance polic held b To a V.V.S.N. S am

Name

To a V.V.S.N. S am

Polic Number

694980091

Plan

149(Jee an Anand)

Polic Term

71

Premium Pa ing Term

20

Commencement Date

12/01/2009

Instalment Premium

27,356.00

Mode Of Premium Pa ment

YLY

Reference Code

65943231

Due

Due To

Number Of

Premium Amount

Received

Collecting

Status

From

Instalments

Received

Date

Branch

01/2012

01/2012

1

27,356.00

10/01/2012

EPS1

No mal

To al amo n ecei ed o a d p emi m fo he polic n mbe 694980091 i R . 27,356.00 fo he financial ea 2011­2012

Thi ce ifica e i elec onicall gene a ed

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