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 (`) (`)
896267712 15/04/2020 1 E089
15/01/2018 463.00 10.40 15/04/2020
Savita Balasaheb Avhad 15/04/2020 Mly 935

896267712 15/05/2020 1 E089

15/01/2018 463.00 10.40 15/05/2020
Savita Balasaheb Avhad 15/05/2020 Mly 935

896267712 15/06/2020 1 E089

15/01/2018 463.00 10.40 15/06/2020
Savita Balasaheb Avhad 15/06/2020 Mly 935

896267712 15/07/2020 1 E089

15/01/2018 463.00 10.40 15/07/2020
Savita Balasaheb Avhad 15/07/2020 Mly 935

896267712 15/08/2020 1 E089

15/01/2018 463.00 10.40 17/08/2020
Savita Balasaheb Avhad 15/08/2020 Mly 935

896267712 15/09/2020 1 E089

15/01/2018 463.00 10.40 15/09/2020
Savita Balasaheb Avhad 15/09/2020 Mly 935

896267712 15/10/2020 1 E089

15/01/2018 463.00 10.40 15/10/2020
Savita Balasaheb Avhad 15/10/2020 Mly 935

896267712 15/11/2020 1 E089

15/01/2018 463.00 10.40 17/11/2020
Savita Balasaheb Avhad 15/11/2020 Mly 935

896267712 15/12/2020 1 E089

15/01/2018 463.00 10.40 15/12/2020
Savita Balasaheb Avhad 15/12/2020 Mly 935

896267712 15/01/2021 1 E089

15/01/2018 463.00 10.40 15/01/2021
Savita Balasaheb Avhad 15/01/2021 Mly 935

896267712 15/02/2021 1 E089

15/01/2018 463.00 10.40 15/02/2021
Savita Balasaheb Avhad 15/02/2021 Mly 935

896267712 15/03/2021 1 E089

15/01/2018 463.00 10.40 15/03/2021
Savita Balasaheb Avhad 15/03/2021 Mly 935
All the above payments are subject to cheque realisation, wherever applicable.

Total amount received towards premium for the policies listed above is ` 5,556.00 for the financial year 2020-
2021.

Total amount received towards Service Tax / GST for the policies listed above is ` 124.8 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.