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 2019-2020

DATE OF ISSUE :20/01/2020

The following premium has been received for life insurance policies of Nitin Gupta

Premium/ Service
Number of Tax / GST
Instalments Additional Received
Policy Number Date Of Due From Amount Coll. Br.
and Premium Date
Policy Holder's Name Commence. Due To Received * Serv. Br.
Payment Amount
mode (`) (`)
123990996 13/05/2019 1 CBK1
13/05/2008 48,413.00 0.00 14/05/2019
Nitin Gupta 13/05/2019 Yly 11E

124871947 28/04/2019 1 CBK1

28/01/2010 26,938.00 0.00 14/05/2019
Nitin Gupta 28/04/2019 Qly 11E

124871947 28/07/2019 1 CBK1

28/01/2010 26,938.00 606.10 01/08/2019
Nitin Gupta 28/07/2019 Qly 11E

124871947 28/10/2019 1 CBK1

28/01/2010 26,938.00 38.40 09/12/2019
Nitin Gupta 28/10/2019 Qly 11E

124871947 28/01/2020 1 EPS1

28/01/2010 26,938.00 0.00 16/01/2020
Nitin Gupta 28/01/2020 Qly 11E

124871948 28/04/2019 1 CBK1

28/01/2010 27,063.00 0.00 14/05/2019
Nitin Gupta 28/04/2019 Qly 11E

124871948 28/07/2019 1 CBK1

28/01/2010 27,063.00 608.92 01/08/2019
Nitin Gupta 28/07/2019 Qly 11E

124871948 28/10/2019 1 CBK1

28/01/2010 27,063.00 38.56 09/12/2019
Nitin Gupta 28/10/2019 Qly 11E

124871948 28/01/2020 1 EPS1

28/01/2010 27,063.00 0.00 16/01/2020
Nitin Gupta 28/01/2020 Qly 11E
All the above payments are subject to cheque realisation, wherever applicable.

Total amount received towards premium for the policies listed above is ` 264,417.00 for the financial year
2019-2020.

Total amount received towards Service Tax / GST for the policies listed above is ` 1291.98 for the financial
year 2019-2020.

* Please note GST is applicable from 1st July, 2017.

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.