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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 2012-2013 DATE OF ISSUE: 05/05/2013

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The following premia have been received under the following life insurance policies of Satej Sudhakar Kelkar

Dt of Due Policy No. Commencement From 944205183 05/03/2011

Number Of Instalments Premium Received Collecting Servicing Email id of Due To and Amount Date Branch Branch Servicing Branch Payment Received Mode 03/2013 03/2013 1 YLY 30,001.00 31/12/2012 942 942 bo_942@licindia.com

All the above payments are subject to cheque realisation, wherever applicable. Total amount received towards premium for the policies listed above is Rs.30,001.00 for the financial year 20122013. This document is electronically generated, for any queries please contact the servicing branch of respective policies.

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