23012017 Conscldated Premium Paid Statomert Life Insurance Corporation of India PCMC, Network Operating Center Ist Floor, Jeevan Seva Annexe S.VRoad, Santacruz(W) ‘Mumbai - 400 054 PREMIUM PAID STATEMENT FOR THE YEAR 2015-2016 DATE OF ISSUE: 23/01/2017 1 following premia have been received under the following life insurance policies of Srinibas Mohanty ‘Number OF Instalments Premium Dtof Due 4 Received Collecting Servicing Email id of Servicing Policy No. Commencement From Due 7 and Amount Date Branch Branch Branch Payment Received Mode 574885268 18/08/2014 08/2015 08/2015 1 HLY 21,302.00 18/08/2015 EPS1_ S8H_—_bo_S8H@licindia.com 574885268 18/08/2014 02/2016 02/2016 1HILY 21,302.00 02/02/2016 EPS1__S8II__bo_S811@licindia.com 598692197 28/02/2012 02/2016 02/2016 1 YLY _ 20,899.00 01/03/2016 EPS1_ 448 -—_bo_448@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.63,503.00 for the financial year 2015-2016, This document is electronically generated, for any queries please contact the servicing branch of respective policies. ipsfcustomeroninelicintICEPSlappmanager/LICeServicellICeServiceHoma?_nfpo=tro8, windowLabel=ConsclidledPrmPaidCort 18ConsolidalecPem... Vt