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NEFT MANDATE FORM

Name of the Policyholder :- ABHIGYAN GOGOI

Policy Number :- 814208482

Name of the Bank :- SBI BANK

Address of Bank :- SBI, KAHILIPARA BRANCH, GUWAHATI- 781019

Account Type :- Savings

Bank Account Number:- 30062611540

IFS code of Bank :- 4420

Mobile Number _ +91-9706008582

e-mail id :- abhi_g12@rediffmail.com

LIC OF INDIA

DR. HEDGEWAR COMM. COMPLEX

2ND FLOOR, SAT RASTA CIRCLE,

JAMNAGAR - PIN-361001

PH: 0288-2675162

Dated : 17/02/2014

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