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Page 1: Customer.onlinelic.in LICEPS Appmanager Generic TaxCert

Life Insurance Corporation of IndiaPCMC, Network Operating Center1st Floor, Jeevan Seva AnnexeS.V.Road, Santacruz(W)Mumbai - 400 054

PREMIUM PAID STATEMENT FOR THE YEAR 2013-2014DATE OF ISSUE: 26/02/2014

The following premia have been received under the following life insurance policies of Chennupati Lakshmi Devi

Policy No. Dt of Commencement

Due From Due To

Number Of Instalments and Payment Mode

Premium Amount Received

Received Date

Collecting Branch

Servicing Branch

Email id of Servicing Branch

843245347 28/12/2008 12/2013 12/2013 1 YLY 10,840.00 28/12/2013 PCMC 67D [email protected]

All the above payments are subject to cheque realisation, wherever applicable.

Total amount received towards premium for the policies listed above is Rs.10,840.00 for the financial year 2013-2014.

This document is electronically generated, for any queries please contact the servicing branch of respective policies.

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