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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: 02/05/2012

This is to certify that the following premium have been received under the following life insurance policy held by Yogesh
Name Policy Number Plan Policy Term Premium Paying Term Commencement Date Instalment Premium Mode Of Premium Payment Reference Code Yogesh 115210555 14(The Endowment Assurance Policy) 25 25 19/08/2008 207.00 MLY 15040735

Due Number Of Due To From Instalments 04/2012 04/2012 1

Premium Amount Received 207.00

Received Collecting Date Branch 30/04/2012 B033

Status Normal

Total amount received towards premium for the policy number 115210555 is Rs. 207.00 for the financial year 2012-2013

This certificate is electronically generated

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