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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 CERTIFICATE FOR THE YEAR


2015-2016 DATE OF ISSUE: 12/02/2013
This is to certify that the following premium have been received under the following
life insurance by Mr. Shoeb Ahmed Siraj Ahmed Ansari
Name
Policy Number
Plan
Policy Term
Premium Paying Term
Commencement Date
Instalment Premium
Mode of Premium Payment
Reference Code

Due
Due To Numbers of
From
Instalments
06/2015 06/2015 1

Mr. Shoeb Ahmed Siraj Ahmed Ansari


31L2-000104226/44/00/000
75(The Money Back Policy 20 Years)
20
20
28/06/2013
70,205.00
YLY

Premium Amount
Received
70,205.00

Received
Date
11/06/2015

Collecting
Branch
60B

Total amount received towards premium for the policy number


Is Rs. 70,205.00 for the financial year 2015-2016

Status
Normal