District Insurance Office :EAST GODAVARI

Financial Year : 2021-2022

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

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

1 April 2021 650 0

2 May 2021 650 0
3 June 2021 650 0
4 July 2021 650 0
5 August 2021 650 0
6 September 2021 650 0
7 October 2021 0 0
8 November 2021 0 0
9 December 2021 0 0
10 January 2022 0 0
11 February 2022 0 0
12 March 2022 0 0

Total credits received during the year : 3900 0

Opening Balance :29900

Current Year Premium Amount :3900
Total Balance :33800

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