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 2021-2022

DATE OF ISSUE :10/12/2021

The following premium has been received for life insurance policies from the userid of Sridhar Goud S

Premium/
Number of Additiona Received Collecting Servicing
Instalment l Date Branch Branch
Policy No. Name Dt. Of Due Due To s and
Commencement From Premium
Payment Amount
mode Received
(`)
3
648639033 Sridhar Goud S 06/12/2013 06/04/2021 06/12/2022 Qly 56,882.00 06/12/2021 6041 6041

All the above payments are subject to cheque realization, wherever applicable.

Total amount received towards premium for the policies listed above is 56,882.00 for the financial year
2021-2022.
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 Customer zone Official will get in touch with you shortly.