LIFE INSURANCE CORPORATION OF INDIA

LIFE INSURANCE CORPORATION OF INDIA

P&GS UNIT, SILCHAR
MEHERPUR, PIN – 788 015, PHONE NO. - 241251

EXISTENCE CERTIFICATE

Branch Manager (P&GS)

LICI, Silchar Divisional Office
Meherpur, Silchar-15
Cachar, Assam

Annuity No. :

This is to certify that Shri/Smt ________________________________________

Whose specimen signature is given below, is alive today, the __________ day of
_______________, 201_.

Signature of Annuitant

Certified By:

Signature:

Name:
Address/Seal:

P.S.: The certificate is to be completed by LICI Class – I Officer/ Gazetted Officer/

Registered Medical Practitioner with Registration No. or Bank Manager with Seal.

*** PLEASE SEND THE ORIGINAL COPY OF EXECUTED EXISTENCE

CERTIFICATE