Life Insurance Corporation of India

PCMC,Network Operating Center

1st Floor,Jeevan Seva Annexe
S.V. Road,SantaCruz(W)
Mumbai - 400 054

PREMIUM PAID STATEMENT FOR THE YEAR 2017-2018

DATE OF ISSUE :29/12/2017

The following premium has been received for life insurance policies from the userid of Mr Umakant Uchappa
Kumbhar

Premium/
Number of Additional Received Collecting Servicing
Instalments Premium Date Branch Branch
Policy No. Name Dt. Of Due Due To and
Commencement From Amount
Payment Received
mode (`)
Kumbhar U U 10/10/2009 10/04/2017 10/04/2017 1 510.00 E089
924917939 18/04/2017 92C
Mly

Kumbhar U U 10/10/2009 10/05/2017 10/05/2017 1 510.00 E089

924917939 17/05/2017 92C
Mly

Kumbhar U U 10/10/2009 10/06/2017 10/06/2017 1 510.00 E089

924917939 16/06/2017 92C
Mly

Kumbhar U U 10/10/2009 10/07/2017 10/07/2017 1 510.00 E089

924917939 19/07/2017 92C
Mly

Kumbhar U U 10/10/2009 10/08/2017 10/08/2017 1 510.00 E089

924917939 18/08/2017 92C
Mly

Kumbhar U U 10/10/2009 10/09/2017 10/09/2017 1 510.00 E089

924917939 19/09/2017 92C
Mly

Kumbhar U U 10/10/2009 10/10/2017 10/10/2017 1 510.00 E089

924917939 21/10/2017 92C
Mly

Kumbhar U U 10/10/2009 10/11/2017 10/11/2017 1 510.00 E089

924917939 20/11/2017 92C
Mly

Kumbhar U U 10/10/2009 10/12/2017 10/12/2017 1 510.00 E089

924917939 18/12/2017 92C
Mly

Kumbhar U U 10/10/2009 10/04/2017 10/04/2017 1 510.00 E089

924917940 18/04/2017 92C
Mly

Kumbhar U U 10/10/2009 10/05/2017 10/05/2017 1 510.00 E089

924917940 17/05/2017 92C
Mly

Kumbhar U U 10/10/2009 10/06/2017 10/06/2017 1 510.00 E089

924917940 16/06/2017 92C
Mly

Kumbhar U U 10/10/2009 10/07/2017 10/07/2017 1 510.00 E089

924917940 19/07/2017 92C
Mly

Kumbhar U U 10/10/2009 10/08/2017 10/08/2017 1 510.00 E089

924917940 18/08/2017 92C
Mly

Kumbhar U U 10/10/2009 10/09/2017 10/09/2017 1 510.00 E089

924917940 19/09/2017 92C
Mly

Kumbhar U U 10/10/2009 10/10/2017 10/10/2017 1 510.00 E089

924917940 21/10/2017 92C
Mly

Kumbhar U U 10/10/2009 10/11/2017 10/11/2017 1 510.00 E089

924917940 20/11/2017 92C
Mly

Kumbhar U U 10/10/2009 10/12/2017 10/12/2017 1 510.00 E089

924917940 18/12/2017 92C
Mly

Y U Kumbhar 28/03/2005 28/06/2017 28/06/2017 1 2,043.00 CBK1

923286778 12/06/2017 933
Qly

Y U Kumbhar 28/03/2005 28/09/2017 28/09/2017 1 2,043.00 933

923286778 28/09/2017 933
Qly
 Y U Kumbhar 28/03/2005 28/12/2017 28/12/2017 1 2,043.00 933
923286778 29/12/2017 933
Qly

Kumbhar U U 12/06/2006 12/06/2017 12/06/2017 1 4,029.00 CBK1

923591223 12/06/2017 933
Yly

All the above payments are subject to cheque realisation, wherever applicable.

Total amount received towards premium for the policies listed above is ` 19,338.00 for the financial year
2017-2018.

This document is electronically generated. In case of any queries, please send SMS as follows -- type "LICHELP
<policy no>" and send it to 9222492224. Our Customerzone Official will get in touch with you shortly.