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 2023-2024

DATE OF ISSUE :24/12/2023

The following premium has been received for life insurance policies of Suman Pal

Premium/ Service
Number of Tax / GST
Instalments Additional Received
Policy Number Date Of Due From Amount Coll. Br.
and Premium Date
Policy Holder's Name Commence. Due To Received * Serv. Br.
Payment Amount
mode (`) (`)
417072190 05/12/2023 1 EPS1
05/12/2006 14,871.00 0.00 04/12/2023
Shrestha Pal L/A 05/12/2023 Yly 41J

458881723 13/06/2023 1 EPS1

13/06/2014 6,235.00 140.28 25/06/2023
Suman Pal 13/06/2023 Yly 577

458897021 07/06/2023 1 EPS1

07/06/2016 6,343.00 142.72 09/05/2023
Suman Pal 07/06/2023 Yly 577

578382455 19/05/2023 1 EPS1

19/05/2010 39,069.00 0.00 09/05/2023
Suman Pal 19/05/2023 Yly 577

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

Total amount received towards premium for the policies listed above is ` 66,518.00 for the financial year
2023-2024.

Total amount received towards Service Tax / GST for the policies listed above is ` 283.00 for the financial year
2023-2024.

* 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.