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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 2015­2016 DATE OF ISSUE: 09/02/2016The following premia have been received under the following lifeinsurance policies of Sri.C.N.Mani Number OfPolicy No. Dt of Due Due To Instalments Premium Received Collecting Servicing Email id of Servicing and Amount Date Branch Branch Branch Commencement From Payment Received Mode716538859 28/03/2002 03/2015 03/2015 1 QLY 907.00 02/04/2015 EPS1 70P [email protected] 28/03/2002 06/2015 09/2015 2 QLY 1,814.00 13/10/2015 EPS1 70P [email protected] 28/03/2002 12/2015 12/2015 1 QLY 907.00 20/12/2015 EPS1 70P [email protected] the above payments are subject to cheque realisation, wherever applicable. Total amount received towards premium for the policies listed above is Rs.3,628.00 for the financial year 2015­2016. This document is electronically generated, for any queries please contact the servicing branch of respectivepolicies.