: : 1 PREMIUM PAID CERTIFICATE FOR THE YEA ge AMBMRAREE CORPORATION OF INDIA L.T.C. OF INDIA BRANCH : 77E DATE : 20/07THRISSUR DIVISION This is to certify that the following payments have been made uncer life insurance policies held by Mr/Ms. Re - Holder Of Permanent Account Nurbor, "e” GOVARONAN REGHURAN Customer Identification Nunber o2e28v018969 Policy ne Due Inst.Prem Comm.Oate Mode Plan-Term-PeT O i “ mn. Oate Mode Plan-Term Date of Pay ‘Policy Holder's Name Ackl.Prem Crit-tll.prm. Cha. ind Remar 317250780 10/2021 2887.00 20/10/2021 ALY 921~25-20 20/10/2021 GOVAROHAN REG@HURAH 0.00 0.00 SERV BRANCH 776 (Sevice Taxtedu Cess) / GST 130.00 317250780 1/2022 2887.00 20/10/2021 ALY 921~25~20 19/01/2022 GOVAROHAN REGHURAM 0.00 0.00) SERV BRANCH 776 (Sevice TaxtEdu Cess) / GST : 129.92 317250781 10/2021 2885.00 20/10/2021 QLY 921-25-20 20/10/2021 VASUDEV REGHURAM 0.00 0.00 SERV BRANCH 776 (Sevice TaxtEdu Cess) / ast 130.00 317250781 1/2022 2885.00 20/10/2021 ALY 3921-25-20 19/01/2022 VASUDEV REGHURAM (0.00 0.00 SERV BRANCH 77E (Sevice TaxtEdu Cess) / 6ST 129-82 11544.00 for fin. year 2021-2022 Total amount paid towards premium is Rs. Total amount paid towards ( Service TaxtEdu. Cess ) / GST 519.74 CHIEF /SR/BRANCH MANAGER PREPD. BY:579109 € PRINTED AT 277E -~ 229 e@ ~ eee7s#ee0e540504o0eees