District Insurance Office :EAST GODAVARI

Financial Year : 2020-2021

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

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

1 April 2020 0 0
2 May 2020 0 0
3 June 2020 650 0
4 July 2020 650 0
5 August 2020 650 0
6 September 2020 0 0
7 October 2020 1300 0
8 November 2020 650 0
9 December 2020 1300 0
10 January 2021 1300 0
11 February 2021 650 0
12 March 2021 650 0

Total credits received during the year : 7800 0

Opening Balance :22100

Current Year Premium Amount :7800
Total Balance :29900

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 :24/11/2021