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 :12/01/2024

The following premium has been received for life insurance policies of B Gopi Krishna

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 (`) (`)

559599802 28/12/2022 2 460

28/12/2022 94,386.00 3,786.08 16/06/2023
B Gopi Krishna 28/12/2024 Yly 460
28/12/2024 1 CBK2
559599802 28/12/2022 62,193.00 2,501.32 23/07/2023
28/12/2024 Yly 460
B Gopi Krishna

All the above payments are subject to cheque realisation, wherever applicable.
Total amount received towards premium for the policies listed above is `1,56,579.00 for the financial year 2023-2024.
Total amount received towards Service Tax / GST for the policies listed above is `6,297.40 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.