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 2019-2020

DATE OF ISSUE :18/02/2020

The following premium has been received for life insurance policies of Sai K Krishnashastrula

Premium/ Service
Number of Tax / GST
Instalments Additional Received
Policy Number Date Of Due From Amount Coll. Br.
and Premium Date
Policy Holder's Name Commence. Due To Received * Serv. Br.
Payment Amount
mode (`) (`)
602335226 03/05/2019 1 EPS1
03/08/2009 1,225.00 0.00 07/05/2019
Krishna Shastrula Saikrishna 03/05/2019 Qly 73H

602335226 03/08/2019 1 EPS1

03/08/2009 1,225.00 0.00 05/08/2019
Krishna Shastrula Saikrishna 03/08/2019 Qly 73H

602335226 03/11/2019 1 EPS1

03/08/2009 1,225.00 0.00 02/11/2019
Krishna Shastrula Saikrishna 03/11/2019 Qly 73H

602335226 03/02/2020 1 EPS1

03/08/2009 1,225.00 0.00 04/02/2020
Krishna Shastrula Saikrishna 03/02/2020 Qly 73H

602385487 28/05/2019 1 EPS1

28/05/2008 5,091.00 0.00 07/05/2019
Krishnashastrula Sai Krishna 28/05/2019 Hly 64T

602385487 28/11/2019 1 EPS1

28/05/2008 5,091.00 0.00 03/11/2019
Krishnashastrula Sai Krishna 28/11/2019 Hly 64T

604778599 22/07/2019 1 EPS1

22/01/2013 13,770.00 0.00 02/07/2019
Krishna Shasthrula Saikrishna V 22/07/2019 Hly 73H

604778599 22/01/2020 1 EPS1

22/01/2013 13,770.00 0.00 01/01/2020
Krishna Shasthrula Saikrishna V 22/01/2020 Hly 73H

606345882 12/05/2019 1 EPS1

12/05/2014 3,342.00 75.20 07/05/2019
Krishnashasthrula Sai Krishna 12/05/2019 Hly 73H

606345882 12/11/2019 1 EPS1

12/05/2014 3,342.00 75.20 03/11/2019
Krishnashasthrula Sai Krishna 12/11/2019 Hly 73H
All the above payments are subject to cheque realisation, wherever applicable.

Total amount received towards premium for the policies listed above is ` 49,306.00 for the financial year
2019-2020.

Total amount received towards Service Tax / GST for the policies listed above is ` 150.40 for the financial year
2019-2020.

* Please note GST is applicable from 1st July, 2017.

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.