District Insurance Office :EAST GODAVARI

Financial Year : 2017-2018

Policy Number :2419979
Employee Name :A KASI SIVA
Designation :VRO

S.NO Month Year Premium Amount (Rs.) Loan Amount (Rs.)

1 April 2017 0 0
2 May 2017 650 0
3 June 2017 650 0
4 July 2017 0 0
5 August 2017 650 0
6 September 2017 1300 0
7 October 2017 0 0
8 November 2017 650 0
9 December 2017 650 0
10 January 2018 650 0
11 February 2018 650 0
12 March 2018 650 0

Total credits received during the year : 6500 0

Opening Balance :0
Current Year Premium Amount :6500
Total Balance :6500

District Insurance Officer

EAST GODAVARI

Note: This is a Computer Generated Report.

The credits shown are only to the extent of Schedules received from DTOs and posted.
1. This Statement of account is subject to E&OE
2. The subscriber is requested to satisfy himself/herself as to the correctness of thestatement and to bring errors,if
any, to the notice of this office within one month from the date of issue with the details of Vr.no.,amount of
voucher,copy of schedule (voucher) under attestation by the DDO concerned.
3. Please quote correct Policy Number in the Schedule (Voucher) and avoid missing credits.
4. In case of transfer, the information may please be informed to District Insurance Office.
5. Proposal Form is compulsory every time whenever the APGLI subscription is increased to obtain additional policies.
6. Proposal forms have to be submitted before (55) years of age to obtain first or subsequent policiesotherwise,excess
premium, if any paid, will be treated as unauthorized amount.

Report Date :21/07/2021