District Insurance Office : Potti Sriramulu Nellore

Financial Year : 2015-2016

Policy No.

L2012110

Employee Name

Ch.Sailaja

Designation

Lp

S.No.

Month

Year

April

2015

May

2015

June

2015

July

2015

August

2015

September

2015

October

2015

November

2015

December

2015

10

January

2016

11

February

2016

12

March

2016

Total credits received during the year :

Opening Balance

450

Current Year Premium Amount

Total Balance

450

Premium Amount (Rs.)

Loan Amount (Rs.)

DISTRICT INSURANCE OFFICER

Potti Sriramulu Nellore

Note: This is a Computer Generated Report.

The credits shown are only to the extent of Schedules received from DTOs and posted.

1. This Statement of account is subject to E&OE

2. The subscriber is requested to satisfy himself/herself as to the correctness of the statement and to bring errors,
if any, to the notice of this office within one month from the date of issue with the details of Vr.no.,amount of
voucher,copy of schedule (voucher) under attestation by the DDO concerned.
3. Please quote correct Policy Number in the Schedule (Voucher) and avoid missing credits.
4. In case of transfer, the information may please be informed to District Insurance Office.
5. Proposal Form is compulsory every time whenever the APGLI subscription is increased to obtain additional
policies.
6. Proposal forms have to be submitted before (53) years of age to obtain first or subsequent policies otherwise,
excess premium, if any paid, will be treated as unauthorized amount.

Report Date :

17/08/2015