8/22/2017 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 CERTIFICATE FOR THE YEAR 2017-2018

DATE OF ISSUE: 22/08/2017

This is to certify that the following premium have been received under the
following life insurance policy held by Priyanshi L.A

Name Priyanshi L.A

Policy Number 116969853
Plan 102(Jeevan Kishore)
Policy Term 20
Premium Paying Term 20
Commencement Date 20/07/2013
Instalment Premium 11,603.00
Mode Of Premium Payment HLY
Reference Code 19885213

Due Number Of Premium Amount Received Collecting

Due To Status
From Instalments Received Date Branch
07/2017 07/2017 1 11,603.00 20/08/2017 CBK1 Normal

Total amount received towards premium for the policy number 116969853
is Rs. 11,603.00 for the financial year 2017-2018

This certificate is electronically generated

https://merchant.onlinelic.in/LICMerchant/appmanager/Generic/TaxCertificateHome?selectedValues=116969853|2017|N|TUNQA6 1/1