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2/701/2017 TaxCertificateHome

Life Insurance C orporation of India


PC MC , Network Operating C e nte r
1st Floor, Jeevan Seva Annexe
S.V.Road, S a n t acruz(W )
Mumbai - 400 054

PREMIUM PAID C ERTIFICATE FOR THE YEAR 2016 - 20 17


DATE OF ISSUE: 27/0 1 /201 7

This is to certify tha t the follow ing premium have been received under the
follow ing life ins ura nce policy held by Charu Mehta

Name Charu Mehta


Policy Number 226213455
Plan 165 (Jeevan Saral)
Policy Term 35
Premium Paying Term 35
Commencement Date 15/02/2012
Instalment Premium 5,000.00
Mode of Premium Payment MLY
Reference Code 14966326

Due Number Of Premium Amount Received Collectin


Due To Status
From Instalment Received Date g Branch
04/2016 04/2016 s1 5,000.00 15/04/2016 B033 Nor mal
05/2016 05/2016 1 5,000.00 15/05/2016 B033 Nor mal
06/2016 06/2016 1 5,000.00 15/06/2016 B033 Nor mal
07/2016 07/2016 1 5,000.00 15/07/2016 B033 Nor mal
08/2016 08/2016 1 5,000.00 15/08/2016 B033 Nor mal
09/2016 09/2016 1 5,000.00 15/09/2016 B033 Nor mal
10/2016 10/2016 1 5,000.00 15/10/2016 B033 Nor mal
11/2016 11/2016 1 5,000.00 15/11/2016 B033 Nor mal
12/2016 12/2016 1 5,000.00 15/12/2016 B033 Nor mal
01/2017 01/2017 1 5,000.00 15/01/2017 B033 Nor mal

T o ta l amount rece ived towards premium for the policy number 226213455
is Rs. 50,000.00 for the financial year 2016-2017

This c ert ificate is elect ronically generated

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