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 :15/04/2024

The following premium has been received for life insurance policies of Koppisetti Yohanu

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 (`) (`)
805378247 12/04/2023 1 PCMC
12/10/2017 7,212.00 162.28 11/05/2023
Koppisetti Yohanu 12/04/2023 Qly 676

805378247 12/07/2023 1 PCMC

12/10/2017 7,212.00 162.28 11/08/2023
Koppisetti Yohanu 12/07/2023 Qly 676

805378247 12/10/2023 1 PCMC

12/10/2017 7,212.00 162.28 13/11/2023
Koppisetti Yohanu 12/10/2023 Qly 676

805378247 12/01/2024 1 PCMC

12/10/2017 7,212.00 162.28 12/02/2024
Koppisetti Yohanu 12/01/2024 Qly 676

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

Total amount received towards premium for the policies listed above is ` 28,848.00 for the financial year
2023-2024.

Total amount received towards Service Tax / GST for the policies listed above is ` 649.12 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.