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 2018-2019

DATE OF ISSUE :29/01/2019

The following premium has been received for life insurance policies from the userid of Lavanya E

Premium/
Number of Additional Received Collecting Servicing
Instalments Premium Date Branch Branch
Policy No. Name Dt. Of Due Due To and
Commencement From Amount
Payment Received
mode (`)
Lavanya E 10/11/2014 10/04/2018 10/04/2018 1 1,334.00 B064
807732537 17/04/2018 64Q
Mly

Lavanya E 10/11/2014 10/05/2018 10/05/2018 1 1,334.00 B064

807732537 17/05/2018 64Q
Mly

Lavanya E 10/11/2014 10/06/2018 10/06/2018 1 1,334.00 B064

807732537 18/06/2018 64Q
Mly

Lavanya E 10/11/2014 10/07/2018 10/07/2018 1 1,334.00 B064

807732537 19/07/2018 64Q
Mly

Lavanya E 10/11/2014 10/08/2018 10/08/2018 1 1,334.00 B064

807732537 23/08/2018 64Q
Mly

Lavanya E 10/11/2014 10/09/2018 10/09/2018 1 1,334.00 B064

807732537 20/09/2018 64Q
Mly

Lavanya E 10/11/2014 10/10/2018 10/10/2018 1 1,334.00 B064

807732537 19/10/2018 64Q
Mly

Lavanya E 10/11/2014 10/11/2018 10/11/2018 1 1,334.00 B064

807732537 19/11/2018 64Q
Mly

Lavanya E 10/11/2014 10/12/2018 10/12/2018 1 1,334.00 B064

807732537 21/12/2018 64Q
Mly

Lavanya E 10/11/2014 10/01/2019 10/01/2019 1 1,334.00 B064

807732537 19/01/2019 64Q
Mly

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

Total amount received towards premium for the policies listed above is ` 13,340.00 for the financial year
2018-2019.

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.