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 2020-2021

DATE OF ISSUE :16/12/2021

The following premium has been received for life insurance policies

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 (`) (`)
895300861 24/04/2020 1 E089
24/09/2013 500.00 0.00 28/04/2020
Savita Balasaheb Avhad 24/04/2020 Mly 935

895300861 24/05/2020 1 E089

24/09/2013 500.00 0.00 28/05/2020
Savita Balasaheb Avhad 24/05/2020 Mly 935

895300861 24/06/2020 1 E089

24/09/2013 500.00 0.00 29/06/2020
Savita Balasaheb Avhad 24/06/2020 Mly 935

895300861 24/07/2020 1 E089

24/09/2013 500.00 0.00 28/07/2020
Savita Balasaheb Avhad 24/07/2020 Mly 935

895300861 24/08/2020 1 E089

24/09/2013 500.00 0.00 28/08/2020
Savita Balasaheb Avhad 24/08/2020 Mly 935

895300861 24/09/2020 1 E089

24/09/2013 500.00 0.00 28/09/2020
Savita Balasaheb Avhad 24/09/2020 Mly 935

895300861 24/10/2020 1 E089

24/09/2013 500.00 0.00 28/10/2020
Savita Balasaheb Avhad 24/10/2020 Mly 935

895300861 24/11/2020 1 E089

24/09/2013 500.00 0.00 30/11/2020
Savita Balasaheb Avhad 24/11/2020 Mly 935

895300861 24/12/2020 1 E089

24/09/2013 500.00 0.00 28/12/2020
Savita Balasaheb Avhad 24/12/2020 Mly 935

895300861 24/01/2021 1 E089

24/09/2013 500.00 0.00 28/01/2021
Savita Balasaheb Avhad 24/01/2021 Mly 935

895300861 24/02/2021 1 E089

24/09/2013 500.00 0.00 01/03/2021
Savita Balasaheb Avhad 24/02/2021 Mly 935

895300861 24/03/2021 1 E089

24/09/2013 500.00 0.00 30/03/2021
Savita Balasaheb Avhad 24/03/2021 Mly 935
All the above payments are subject to cheque realisation, wherever applicable.

Total amount received towards premium for the policies listed above is ` 6,000.00 for the financial year 2020-
2021.

Total amount received towards Service Tax / GST for the policies listed above is ` 0.00 for the financial year
2020-2021.

* 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.