Life Insurance Corporation of India

PCMC,Network Operating Center

1st Floor,Jeevan Seva Annexe
S.V. Road,SantaCruz(W)
Mumbai - 400 054

PREMIUM PAID STATEMENT FOR THE YEAR 2017-2018

DATE OF ISSUE :06/11/2017

The following premium has been received for life insurance policies from the userid of Ashish Tripathi

Premium/
Number of Additional Received Collecting Servicing
Instalments Premium Date Branch Branch
Policy No. Name Dt. Of Due Due To and
Commencement From Amount
Payment Received
mode (`)
A K Tripathi 14/01/2011 14/07/2017 14/07/2017 1 5,462.00 EPS1
386518929 01/07/2017 381
Hly

Tripathi 15/09/2005 15/03/2017 15/03/2017 1 1,124.00 EPS1

383963909 09/04/2017 383
Hly

Tripathi 15/09/2005 15/09/2017 15/09/2017 1 1,124.00 EPS1

383963909 06/09/2017 383
Hly

Tripathi 15/09/2005 15/03/2017 15/03/2017 1 2,199.00 EPS1

383963837 09/04/2017 383
Hly

Tripathi 15/09/2005 15/09/2017 15/09/2017 1 2,199.00 EPS1

383963837 06/09/2017 383
Hly

Tripathi Ak 14/05/2008 14/05/2017 14/05/2017 1 2,313.00 EPS1

234309229 01/05/2017 232
Yly

A K Tripathi 01/10/2007 01/04/2017 01/04/2017 1 4,093.00 EPS1

385272146 24/04/2017 381
Hly

A K Tripathi 01/10/2007 01/10/2017 01/10/2017 1 4,093.00 EPS1

385272146 21/10/2017 381
Hly

A K Tripathi 01/03/2006 01/09/2017 01/09/2017 1 3,357.00 EPS1

383265469 16/08/2017 381
Hly

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

Total amount received towards premium for the policies listed above is ` 25,964.00 for the financial year
2017-2018.

This document is electronically generated. In case of any queries, please send SMS as follows -- type "LICHELP
<policy no>" and send it to 9222492224. Our Customerzone Official will get in touch with you shortly.