A3B75ED2-83CC-4A60-8FBB-E38FF45BA421

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 2018-2019 DATE OF ISSUE :27/12/2018 The following premium has been received for life insurance policies from the userid of Omkumarvani Devaraj Number of Premium/ Received Collecting Servicing Instalments Additional Policy No. Name Dt. Of Due Due To Premium Date Branch Branch and 714872540 Omkumar D Commencement From Payment Amount 714872540 Omkumar D Received 714872540 Omkumar D mode 715468329 (`) 715468329 Vanitha P 04/05/2007 04/05/2018 04/05/2018 1 954.00 16/05/2018 7126 7126 715468329 Vanitha P Qly 17/08/2018 7126 7126 706441786 Vanitha P 954.00 16/11/2018 7126 7126 Omkumar D 04/05/2007 04/08/2018 04/08/2018 1 06/04/2018 7126 7126 Qly 954.00 19/06/2018 7126 7126 28/09/2018 7126 7126 04/05/2007 04/11/2018 04/11/2018 1 864.00 13/07/2018 7126 7126 Qly 864.00 08/09/2009 08/03/2018 08/03/2018 1 Qly 864.00 08/09/2009 08/06/2018 08/06/2018 1 24,020.00 Qly 08/09/2009 08/09/2018 08/09/2018 1 Qly 09/07/2012 09/07/2018 09/07/2018 1 Yly All the above payments are subject to cheque realisation, wherever applicable. Total amount received towards premium for the policies listed above is ` 29,474.00 for the financial year 2018-2019. 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.