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 2021-2022

DATE OF ISSUE :11/07/2022

The following premium has been received for life insurance policies

Premium/ Service
Number of Tax / GST
Instalments Additional Received
Policy Number Date Of Premium Amount
Policy Holder's Name Commence. and Received Date
Payment Amount
*
mode (`)
(`)
244634317 1
17/02/2019 36,347.00 921.40 03/04/2021
Harshdeep Yly
Bhardwaj Cash
244638517 1
15/09/2019 36,347.00 869.60 15/06/2021
Harshdeep Yly
Bhardwaj Cash
348561257 1
23/01/2020 25,486.00 758.62 17/08/2021
Harshdeep Yly
Bhardwaj Cash
258963512 1
25/03/2020 38,696.00 827.65 30/09/2021
Harshdeep Yly
Bhardwaj Cash
466859741 1
05/07/2020 38,696.00 865.14 31/03/2022
Harshdeep Yly
Bhardwaj Cash

All the above payments are subject to cheque realisation, wherever applicable.
Total amount received towards premium for the policies listed above is ` 1,75,572.00 for the financial year
2021-2022.

Total amount received towards Service Tax / GST for the policies listed above is ` 4,2425.41 for the financial
year 2021-2022.

* Please note GST is applicable from 1st July, 2017.

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.