7/27/2015 TaxCertificateHome

Life Insurance Corporation of India
PCMC, Network Operating Center
1st Floor, Jeevan Seva Annexe
S.V.Road, Santacruz(W)
Mumbai ­ 400 054

PREMIUM PAID CERTIFICATE FOR THE YEAR 2011­2012
DATE OF ISSUE: 27/07/2015

This is to certify that the following premium have been received under
the following life insurance policy held by Kota Ravi

Name Kota Ravi
Policy Number 685149538
Plan 179(New Bima Gold)
Policy Term 20
Premium Paying Term 20
Commencement Date 22/12/2008
Instalment Premium 4,856.00
Mode Of Premium Payment QLY
Reference Code 69111588

Due Number Of Premium Amount Received Collecting

Due To Status
From Instalments Received Date Branch
03/2011 03/2011 1 4,856.00 12/05/2011 EPS1 Normal
06/2011 06/2011 1 4,856.00 31/07/2011 EPS1 Normal
09/2011 09/2011 1 4,856.00 23/09/2011 EPS1 Normal
12/2011 12/2011 1 4,856.00 22/12/2011 EPS1 Normal

Total amount received towards premium for the policy number
685149538 is Rs. 19,424.00 for the financial year 2011­2012

This certificate is electronically generated 

https://customer.onlinelic.in/LICEPS/appmanager/Generic/TaxCertificateHome?selectedValues=fiuy8e|685149538|2011| 1/1