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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 2012-2013 DATE OF ISSUE: 06/01/2013

This is to certify that the following premium have been received under the following life insurance policy held by Manjunath M
Name Policy Number Plan Policy Term Premium Paying Term Commencement Date Instalment Premium Mode Of Premium Payment Reference Code Manjunath M 629068243 149(Jeevan Anand) 70 21 20/11/2008 25,974.00 HLY 69829193

Due From

Due To

Number Of Instalments

Premium Amount Received 25,974.00 25,974.00

Received Date 18/06/2012 15/11/2012

Collecting Branch 627 617

Status Normal Normal

05/2012 05/2012 1 11/2012 11/2012 1

Total amount received towards premium for the policy number 629068243 is Rs. 51,948.00 for the financial year 2012-2013

This certificate is electronically generated

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1/6/2013 11:05 AM