District Insurance Office : West Godavari

Financial Year : 2010-2011

Policy No.

2305939

Employee Name

K Sasidhar

Designation

AE

S.No.

Month

Year

April

2010

May

2010

June

2010

July

2010

August

2010

600

September

2010

600

October

2010

600

November

2010

600

December

2010

600

10

January

2011

600

11

February

2011

600

12

March

2011

600

4,800

Total credits received during the year :

Opening Balance

Current Year Premium Amount

4,800

Total Balance

4,800

Premium Amount (Rs.)

Loan Amount (Rs.)

DISTRICT INSURANCE OFFICER

West Godavari

Note: This is a Computer Generated Report.

The credits shown are only to the extent of Schedules received from DTOs and posted.

1. This Statement of account is subject to E&OE

2. The subscriber is requested to satisfy himself/herself as to the correctness of the statement and to bring errors,
if any, to the notice of this office within one month from the date of issue with the details of Vr.no.,amount of
voucher,copy of schedule (voucher) under attestation by the DDO concerned.
3. Please quote correct Policy Number in the Schedule (Voucher) and avoid missing credits.
4. In case of transfer, the information may please be informed to District Insurance Office.
5. Proposal Form is compulsory every time whenever the APGLI subscription is increased to obtain additional
policies.
6. Proposal forms have to be submitted before (53) years of age to obtain first or subsequent policies otherwise,
excess premium, if any paid, will be treated as unauthorized amount.

Report Date :

15/11/2016