Branch: 58A AT/PO- ALARA VIA-

NARASINGHPUR
SANJAYA KUMAR NATH DIST-CUTTACK
Agent : LIC0211858A ODISHA
Leader :0392058 PIN:754032

0211858A Premium due & Default List for the Month of 08/2021 Page : 1

Sl. Policy Policy Holder Name D.o.C. Plan - M F.U.P. Instlmnt D G S T Total Estm.
No. Number Term od Premium ue Premium Comn
1 828765759 SAROJA KUMAR MOHANTY 15/09/2018 814-16 H 03/2021 3414 1 77.00 3491 256
2 597187453 GITANJALI NAYAK 20/03/2015 814-16 Y 03/2021 6473 1 146.00 6619 324
3 574816138 PRAMODINI NATH 28/03/2014 815-16 Q 03/2021 1946 2 88.00 3980 195
4 574816139 RUDRAPRATAP BHUYAN 28/03/2014 814-16 H 03/2021 3265 1 74.00 3339 163
5 597304951 SUJATA CHANDA 28/03/2016 814-16 H 03/2021 3324 1 75.00 3399 166
6 824662747 SUCHARITA BEHERA 28/03/2018 814-16 H 03/2021 3329 1 75.00 3404 166
7 849773441 PRAKASH BISWAL 05/04/2017 814-16 H 04/2021 3366 1 76.00 3442 168
8 828768329 IJAK BALABANTRAY 15/10/2018 832-23 Q 04/2021 1319 2 59.00 2697 198
9 574805007 SUDHIR BEHERA 28/10/2013 149-54 H 04/2021 4876 1 0.00 4876 244
10 574805008 DILLIP KUMAR BARIKI 28/10/2013 149-74 H 04/2021 3386 1 0.00 3386 169
11 574817730 LAXMIPRIYA NAYAK 28/04/2014 814-17 H 04/2021 3107 1 70.00 3177 155
12 574817731 DURYODHAN MOHANTY 28/04/2014 814-16 Q 04/2021 1691 2 76.00 3458 169
13 597146785 PUSPALATA MAHARANA 28/10/2014 814-16 H 04/2021 3359 1 76.00 3435 168
14 597158683 RANJAN KUMAR SUBUDHI 28/01/2015 814-16 Q 04/2021 1689 2 76.00 3454 169
15 828765760 RAJIB LOCHAN NAYAK 09/05/2018 814-17 H 05/2021 3126 1 70.00 3196 156
16 597337735 KAILASH CHANDRA CHANDA 20/05/2016 814-16 Y 05/2021 12785 1 288.00 13073 639
17 856895859 BISWAJIT BARIKI 02/06/2020 934-24 H 06/2021 4667 1 105.00 4772 350
18 574808427 RANJIT KUMAR MOHANTY 23/12/2013 149-73 H 06/2021 3403 1 0.00 3403 170
19 597336799 BAURIA BEHERA 27/06/2016 814-16 Y 06/2021 6597 1 148.00 6745 330
20 574811962 PRAMOD BEHERA & S BAHUBALENDRA 28/12/2013 089-16 Q 06/2021 1874 1 0.00 1874 94
21 574811977 SATYA SADHAN NATH 28/12/2013 178-89 H 06/2021 3534 1 0.00 3534 177
22 597158909 JAHNABI BHUYAN 10/01/2015 814-16 H 07/2021 3349 1 75.00 3424 167
23 597222706 JYOTISMITA NAYAK 14/07/2015 814-15 Y 07/2021 7087 1 160.00 7247 354
24 574819529 SUBASH CHANDRA CHANDA 15/07/2014 814-15 Q 07/2021 1809 1 41.00 1850 90
25 597157518 PRIYAMBADA BEHERA 19/01/2015 814-16 H 07/2021 3324 1 75.00 3399 166
26 849691610 BISWA RANJAN CHINNERA 19/01/2017 814-15 H 07/2021 3574 1 80.00 3654 179
27 849691611 JYOTI RANJAN CHINNERA 19/01/2017 814-15 H 07/2021 3664 1 82.00 3746 183
28 849787808 LITUN KUMAR CHANDA 24/01/2020 815-20 Q 07/2021 1456 1 33.00 1489 109
29 849787810 SUMITRA MOHANTY 24/01/2020 815-18 Q 07/2021 1781 1 40.00 1821 134
30 574819971 LOKANATH MOHANTY 28/07/2014 814-16 Q 07/2021 1834 1 41.00 1875 92
31 849789639 BASUDEV PRUSTY 28/01/2020 815-19 Q 07/2021 1756 1 40.00 1796 132
32 849789641 NAROTTAM BEHERA 28/01/2020 836-21 Q 07/2021 3055 1 69.00 3124 229
33 856291626 YOGATMIKA KHATUA 28/05/2020 936-21 M 07/2021 1178 2 53.00 2409 177
34 856292365 BISHNU PRASAD DAS 02/05/2020 936-21 Q 08/2021 3491 1 79.00 3570 262
35 857847013 NAKULA MUDULI 08/02/2021 936-21 Q 08/2021 3087 1 139.00 3226 772
36 857847014 KETAKI NAYAK 08/02/2021 914-16 H 08/2021 3733 1 168.00 3901 933
37 857885942 NITYA RANJAN NAYAK 08/02/2021 914-18 H 08/2021 3508 1 158.00 3666 877
38 828199069 MANAS ROUT 09/08/2018 814-16 H 08/2021 3625 1 82.00 3707 181
39 840280377 PRIYA RANJAN BISWAL 10/02/2019 814-18 Q 08/2021 1914 1 43.00 1957 144
40 840280356 LAXMIDHAR SAHOO 11/02/2019 814-18 H 08/2021 3769 1 85.00 3854 283
41 574800016 CHITTA RANJAN DAS 14/08/2013 179-16 H 08/2021 2859 1 0.00 2859 143
42 574800017 SUJATA NAYAK 14/08/2013 179-12 H 08/2021 3015 1 0.00 3015 151

Page Totals : Premium : 143398.00 G S T : 3122.00 Commission : 10384.00

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58A-0211858A - (03/08/2021 17:49:47)
0211858A Premium due & Default List for the Month of 08/2021 Page : 2

Sl. Policy Policy Holder Name D.o.C. Plan - M F.U.P. Instlmnt D G S T Total Estm.
No. Number Term od Premium ue Premium Comn
43 597122694 BIBHUTI PRASAD BEHERA 14/08/2014 814-16 Y 08/2021 7999 1 180.00 8179 400
44 856895856 NIRODA BARIKI 14/08/2020 936-21 H 08/2021 5391 1 121.00 5512 404
45 856895857 NIRANJAN MOHANTY 14/08/2020 914-18 Q 08/2021 1696 1 38.00 1734 127
46 856291056 CHITTA RANJAN DAS 15/05/2020 936-21 M 08/2021 2107 1 47.00 2154 158
47 857478906 SUPRIYA BEHERA 18/01/2021 936-21 M 08/2021 1629 1 73.00 1702 407
48 840288620 PRABHAT KUMAR MOHANTY 19/02/2019 833-18 H 08/2021 3424 1 77.00 3501 257
49 597159084 NISHAMANI DAS 23/02/2015 827-16 H 08/2021 2743 1 62.00 2805 103
50 849787807 SANJAYA KUMAR NATH 24/01/2020 815-19 M 08/2021 585 1 13.00 598 44
51 849649993 KAMALA SAHOO 26/08/2016 814-16 Y 08/2021 6681 1 150.00 6831 334
52 856923525 SUSANTA KUMAR BISWAL 28/09/2020 936-21 M 08/2021 1431 1 64.00 1495 358

Page Totals : Premium : 33686.00 G S T : 825.00 Commission : 2592.00

Grand Totals : Premium : 177084.00 G S T : 3947.00 Commission : 12976.00

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58A-0212358A - (03/08/2021 17:49:47)