Life Insurance Corporation of India

PCMC, Network Operating Center

1st Floor, Jeevan Seva Annexe
S.V.Road, Santacruz(W)
Mumbai - 400 054

PREMIUM PAID CERTIFICATE FOR THE YEAR 2012-2013

DATE OF ISSUE: 31/03/2014

This is to certify that the following premium have been received under the
following life insurance policy held by Smt.Monika Sharma

Name Smt.Monika Sharma

Policy Number 253193152
Plan 75(The Money Back Policy - 20 Years)
Policy Term 20
Premium Paying Term 20
Commencement Date 28/03/2003
Instalment Premium 1,587.00
Mode Of Premium Payment HLY
Reference Code 22784822

Due Number Of Premium Amount Received Collecting

Due To Status
From Instalments Received Date Branch
03/2012 03/2012 1 1,587.00 02/05/2012 PCMC Normal
09/2012 09/2012 1 1,587.00 30/10/2012 PCMC Normal

Total amount received towards premium for the policy number 253193152 is
Rs. 3,174.00 for the financial year 2012-2013

This certificate is electronically generated