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TaxCertificateHome

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 2011-2012 DATE OF ISSUE: 10/02/2013

The following premia have been received under the following life insurance policies of Miss. Prathima N Gaitonde

Policy No.

Dt of Due Commencement From

Number Of Instalments Premium Received Due To and Amount Date Payment Received Mode 407.00 407.00

Collecting Servicing Email id of Servicing Branch Branch Branch 63B 638 63B bo_63B@licindia.com bo_638@licindia.com bo_63B@licindia.com

633027576 28/07/2000 639105555 28/09/2007 633027576 28/07/2000

04/2011 04/2011 1 QLY 09/2011 09/2011 1 YLY 07/2011 07/2011 1 QLY

01/05/2011 EPS1 10/09/2011 EPS1

7,731.00 10/09/2011 EPS1

All the above payments are subject to cheque realisation, wherever applicable. Total amount received towards premium for the policies listed above is Rs.8,545.00 for the financial year 2011-2012. This document is electronically generated, for any queries please contact the servicing branch of respective policies.

https://customer.onlinelic.in/LICEPS/appmanager/Generic/TaxCertificateHome?selectedValues=123456789| 2011| CONS

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