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 :01/01/2022

The following premium has been received for life insurance policies of Suraj Kumar

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 (`) (`)
849392006 21/06/2021 1 EPS1
21/12/2020 11,041.00 496.84 30/06/2021
Suraj Kumar 21/06/2021 Hly 51G

849392006 21/12/2021 1 CBK1

21/12/2020 11,041.00 248.42 31/12/2021
Suraj Kumar 21/12/2021 Hly 51G

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

Total amount received towards premium for the policies listed above is ` 22,082.00 for the financial year
2021-2022.

Total amount received towards Service Tax / GST for the policies listed above is ` 745.26 for the financial year
2021-2022.

* 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.