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 :20/02/2024

The following premium has been received for life insurance policies of Santosh Dagdu Gaikwad

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 (`) (`)
915782246 07/05/2023 1 CBK3
07/03/2023 4,308.00 200.00 04/06/2023
Santosh Dagdu Gaikwad 07/05/2023 Mly 95B

915782246 07/06/2023 1 CBK3

07/03/2023 4,308.00 193.86 11/06/2023
Santosh Dagdu Gaikwad 07/06/2023 Mly 95B

915782246 07/07/2023 1 CBK3

07/03/2023 4,308.00 193.86 22/07/2023
Santosh Dagdu Gaikwad 07/07/2023 Mly 95B

915782246 07/08/2023 2 CBK3

07/03/2023 8,616.00 400.60 29/09/2023
Santosh Dagdu Gaikwad 07/09/2023 Mly 95B

915782246 07/10/2023 1 CBK3

07/03/2023 4,308.00 200.00 02/11/2023
Santosh Dagdu Gaikwad 07/10/2023 Mly 95B

915782246 07/11/2023 2 EPS1

07/03/2023 8,616.00 406.14 04/01/2024
Santosh Dagdu Gaikwad 07/12/2023 Mly 95B

915782246 07/01/2024 1 EPS1

07/03/2023 4,308.00 198.16 01/02/2024
Santosh Dagdu Gaikwad 07/01/2024 Mly 95B

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

Total amount received towards premium for the policies listed above is ` 38,772.00 for the financial year
2023-2024.

Total amount received towards Service Tax / GST for the policies listed above is ` 1792.62 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.