Branch: 34M SADAR-BAZAR ,GANDHAWANI

SHRI GOPAL RATANLAL RATHOD POST.GANDHAWANI DIST.DHAR

Agent : LIC0045934M
Leader :0034170 PIN:454446

0045934M Premium due & Default List for the Month of 09/2019 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
MR.LOKESH KUMAR S/O.GHISALAL CHOUH
1 342424951 22/05/2000 075-20 H 05/2019 1613 1 0.00 1613 97
2 342426686 SHRI OMPRAKASH RATHOR 15/11/2000 075-20 H 05/2019 1589 1 0.00 1589 95
3 345175982 SMT KIRANBALA AKHTARALI SAIYED 24/11/2008 165-30 H 05/2019 6065 1 0.00 6065 303
4 344442819 SHRI BABULAL ARYA 28/12/2003 075-20 H 06/2019 1685 1 0.00 1685 101
5 344447592 MONIKA SADASHIV BARFA 28/12/2004 149-76 H 06/2019 3593 1 0.00 3593 180
6 344449683 DHARMENDRA KALUSINGH CHOUHAN 28/06/2005 075-20 H 06/2019 3353 1 0.00 3353 201
7 344452391 SHR JITESH KUMAR JAIN 21/12/2005 165-21 H 06/2019 18195 1 0.00 18195 910
8 344452787 MR SATISH BASANTILAL SHARMA 22/12/2005 174-20 H 06/2019 1789 1 0.00 1789 89
9 344454543 SMT. HANSHA PARWATSINGH NIGAM 28/12/2005 174-20 H 06/2019 1838 1 0.00 1838 92
10 344454545 MUKESH NARAYANJI RATHOD 28/12/2005 174-16 H 06/2019 5431 1 0.00 5431 272
11 344456446 VIPIN PRAKASH KHANDELWAL 28/03/2006 174-20 Q 06/2019 999 2 0.00 1998 100
12 344457018 RENU VIPIN KHANDELWAL 28/03/2006 174-20 Q 06/2019 946 2 0.00 1892 95
13 344458314 NANURAM MEHATABSINGH KEWADA 28/06/2006 165-25 Y 06/2019 3603 1 0.00 3603 180
14 347951964 SRI SOHAN S/O GHISAJI BHAYAL 06/06/2013 089-24 Y 06/2019 4133 1 0.00 4133 207
SRI.PAWANKUMAR ONKARSINGH UCHCHAWA
15 342427701 15/01/2001 075-20 Q 07/2019 802 1 0.00 802 48
16 344450069 SANDEEP LAXMINARAYAN RATHORE 28/07/2005 150-30 Y 07/2019 1404 1 0.00 1404 84
17 344450075 SHRI AJAY SINGH DABI 28/07/2005 150-30 Y 07/2019 1254 1 0.00 1254 75
18 344450077 SHRI DINESH GOVIND RATHORE 28/07/2005 150-25 Y 07/2019 1542 1 0.00 1542 93
19 344450108 JITENDRA RAMESHCHAND RATHOD 28/07/2005 150-30 Y 07/2019 3119 1 0.00 3119 187
DILIP KUMAR S/O RAMNARAYAN MISTRI
20 344450178 28/07/2005 150-26 Y 07/2019 1450 1 0.00 1450 87
21 344450196 RAJENDRA RUPAJI BARFA 28/07/2005 150-29 Y 07/2019 1350 1 0.00 1350 81
22 344450233 HEMNAT NATHULAL DHARWAL 28/07/2005 150-30 Y 07/2019 1269 1 0.00 1269 76
23 344450242 SHAILENDRA RATHORE 28/07/2005 150-30 Y 07/2019 1248 1 0.00 1248 75
24 344450290 SHRI PRAVEEN JAMADARI 28/07/2005 150-30 Y 07/2019 1286 1 0.00 1286 77
25 344450306 MR TILOK CHANDRA D RATHORE 28/07/2005 150-20 Y 07/2019 2129 1 0.00 2129 128
SHRI SANTOSH LAXMINARAYAN RATHORE
26 344450328 28/07/2005 150-30 Y 07/2019 1586 1 0.00 1586 95
27 344450387 SADASHIV RUPAJI BARFA 28/07/2005 150-30 Y 07/2019 8534 1 0.00 8534 512
28 344450956 BADRILAL SUKHLAL RATHOD 28/07/2005 014-18 Y 07/2019 4282 1 0.00 4282 214
29 344453574 SAJAUDDIN BABU KHAN 25/01/2006 174-20 H 07/2019 2083 1 0.00 2083 104
30 344453578 SRI AKTARALI SAIYYAD 25/01/2006 174-20 H 07/2019 2388 1 0.00 2388 119
31 344454021 SH. AKHILESH SHANKARLAL ARYA 15/01/2006 174-20 Q 07/2019 1657 1 0.00 1657 83
SH. RAJENDRA MOHANLAL SURIYWANSHI
32 344455461 28/01/2006 174-16 H 07/2019 2690 1 0.00 2690 135
33 347963353 SMT SANGEETA MANDLOI 28/07/2014 815-16 H 07/2019 3733 1 84.00 3817 187
34 347967857 SHRI KUNWARSINGH KANASH 28/01/2015 815-17 H 07/2019 4114 1 93.00 4207 206
35 344442818 SHRI SANTOK SINGH 28/02/2004 075-20 H 08/2019 1451 1 0.00 1451 87
36 344445673 SRI BADRILAL DAWAR 15/08/2004 075-20 H 08/2019 1794 1 0.00 1794 108
37 344446043 SMT. KEKADIBAI DAWAR 15/08/2004 075-20 H 08/2019 1760 1 0.00 1760 106
38 344447521 MANU GEHLOT 22/02/2005 075-20 H 08/2019 1809 1 0.00 1809 109
39 344448272 AMAN LOKESH CHOUHAN 26/08/2004 159-26 H 08/2019 3852 1 0.00 3852 193
40 344450570 VIJAY KAILASH RATHOD 25/08/2005 150-30 Y 08/2019 1307 1 0.00 1307 78
41 344450695 SMT SANGEETA RATHOD 26/08/2005 150-27 Y 08/2019 1368 1 0.00 1368 82
SH. ASHVINISINGH UTTAMSINGH SOLANK
42 344450862 22/08/2005 149-66 H 08/2019 2795 1 0.00 2795 140

Page Totals : Premium : 118888.00 G S T : 177.00 Commission : 6491.00

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34M-0045934M - (29/08/2019 16:53:50)
0045934M Premium due & Default List for the Month of 09/2019 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 344450955 SMT. NITA W/O KAMLESH RATHOD 28/08/2005 168-17 Y 08/2019 6861 1 0.00 6861 343
44 344454022 SH.DAMODAR DHANNALAL SHARMA 06/02/2006 174-20 H 08/2019 2217 1 0.00 2217 111
45 344454023 KU SONALI NARENDRA SONI 06/02/2006 174-20 H 08/2019 1784 1 0.00 1784 89
46 344454363 SH. DHARMENDRA RATHOD 14/02/2006 174-20 H 08/2019 1803 1 0.00 1803 90
47 344454690 SRI. PRONAY BISWAS 28/02/2006 174-20 H 08/2019 8392 1 0.00 8392 420
48 344459029 RAHUL VIJAY PANDE 28/05/2006 102-16 Q 08/2019 856 1 0.00 856 43
49 345198698 SRI RAJAT SHYAMJI MALI 28/11/2010 165-35 Q 08/2019 3062 1 0.00 3062 153
50 346836764 SRI MADANLAL S/O RATANLAL RATHOD 13/02/2012 807-17 H 08/2019 5310 1 120.00 5430 266
51 346842267 RAMESH MANGLIYA WASKEL 28/08/2012 165-25 Y 08/2019 7431 1 0.00 7431 372
52 347967814 SHRI DEVPRASAD KANASH 28/02/2015 820-20 H 08/2019 3926 1 88.00 4014 196
53 347970159 MAST KETAN RATHOD 28/08/2015 814-17 Y 08/2019 11693 1 263.00 11956 585
SRI DEVISINGH S/O BIJANSINGH NARGE
54 347974007 28/02/2016 833-17 H 08/2019 4430 1 100.00 4530 222
55 347982589 SRI RAMESHWAR MALVIYA 28/08/2017 841-16 Y 08/2019 9837 1 221.00 10058 738
56 347982590 SMT SANGEETA MALVIYA 28/08/2017 841-16 Y 08/2019 9568 1 215.00 9783 718
57 347987089 SRI SHYAM RATHOD 28/02/2018 836-21 H 08/2019 18902 1 425.00 19327 1418
58 347987090 SRI KETAN RATHOD 28/02/2018 836-21 H 08/2019 18884 1 425.00 19309 1416
59 347987091 SRI ROUNAK RATHOD 28/02/2018 836-21 H 08/2019 18988 1 427.00 19415 1424
60 342423782 SRI GOKUL S/O MOTILAL MANVE 11/03/2000 075-20 H 09/2019 841 1 0.00 841 50
61 342424995 SHRI MANSINGH FATITA KANASH 07/06/2000 075-20 Q 09/2019 816 1 0.00 816 49
62 342893416 SHRI KAILASH CHANDRA SEN 09/03/2002 125-20 Q 09/2019 1078 1 0.00 1078 65
63 342893739 SRI JAY DABI 28/03/2002 075-20 H 09/2019 1587 1 0.00 1587 95
64 342893813 SRI SANJAY DABI 28/03/2002 075-20 Q 09/2019 652 1 0.00 652 39
65 342896227 SRI GAJENDRA CHOUHAN 28/12/2002 075-20 Q 09/2019 819 1 0.00 819 49
66 342899968 SHRI DINESH RATHOD 28/09/2003 075-20 Y 09/2019 6481 1 0.00 6481 389
67 342899970 SHRI DINESH RATHOD 28/09/2003 103-19 Y 09/2019 5856 1 0.00 5856 351
68 342899978 SHRI SOHANLAL BHAYAL 28/09/2003 075-20 Y 09/2019 3309 1 0.00 3309 199
SHRI RAJENDRA RATHOD & SMT. SANJUL
69 344440026 28/09/2003 089-21 Y 09/2019 2982 1 0.00 2982 149
70 344443880 MAST ROHAN PIPLAD [LA] 28/03/2004 102-20 Q 09/2019 633 1 0.00 633 32
71 344443903 SMT.KIRAN PIPLAD 28/03/2004 075-20 Q 09/2019 845 1 0.00 845 51
72 344448978 MAHESHCHANDRA BHAGWAN SHIVDE 28/03/2005 075-20 Q 09/2019 914 1 0.00 914 55
73 344448997 SHANKARLAL MANNAJI JAMADARI 05/03/2005 075-20 Q 09/2019 1809 1 0.00 1809 109
74 344449008 DILIP MAMTA RATHOD 28/03/2005 089-16 H 09/2019 3997 1 0.00 3997 200
75 344449106 AYUSH BAXLA 28/03/2005 159-26 Q 09/2019 1908 1 0.00 1908 95
76 344450941 MUKESH NARENDRASINGH DABI 23/09/2005 089-21 Y 09/2019 3123 1 0.00 3123 156
77 344454953 SMT.SAVITRI CHANDERSINGH MANDLOI 13/03/2006 174-20 H 09/2019 3699 1 0.00 3699 185
78 344455358 SHRI LAKHANSINGH DANGI 17/03/2006 174-20 Q 09/2019 531 1 0.00 531 27
79 344456445 DINESH CHANDRA MALVIYA 28/03/2006 174-20 Q 09/2019 1015 1 0.00 1015 51
80 344456547 SHOBHARAM TERSINGH NIGWAL 28/03/2006 174-20 H 09/2019 1917 1 0.00 1917 96
81 344456580 MR RAJESH JAGDISH MALVIYA 28/03/2006 174-16 H 09/2019 3217 1 0.00 3217 161
SMT.BHARTI PANDEY W/O SHRI ANIL PA
82 344456717 28/03/2006 174-20 Q 09/2019 1905 1 0.00 1905 95
83 344456737 SHAKIL JALIL SHAHA 28/03/2006 174-20 Q 09/2019 859 1 0.00 859 43
84 344456741 MAST RITESH KAILASH PARMAR 28/03/2006 174-20 H 09/2019 1687 1 0.00 1687 84
85 344457159 MAST NIKHIL AJAY RATHOD 28/03/2006 178-88 H 09/2019 6944 1 0.00 6944 347
86 344457203 MANISH HIRALAL PATIDAR 28/03/2006 174-20 H 09/2019 1841 1 0.00 1841 92
87 344457443 ANIL NARAYAN PATIDAR 28/03/2006 174-20 Q 09/2019 957 1 0.00 957 48
88 344457526 RAJENDRA SHOBHARAM RATHOD 28/03/2006 174-20 Q 09/2019 2172 1 0.00 2172 109
89 344457584 RAMA KANAJI SOLANKI 28/03/2006 174-20 H 09/2019 3608 1 0.00 3608 180
90 344457746 SMT SUNITA MOHAN BARFA 28/03/2006 174-20 H 09/2019 1826 1 0.00 1826 91
91 344459026 MAST DAKSHA JAMADARI 25/09/2006 159-26 Y 09/2019 7281 1 0.00 7281 364
92 345173979 MAMTA W/O ANILJI RATHORE 17/09/2008 165-35 Y 09/2019 6005 1 0.00 6005 300

Page Totals : Premium : 217058.00 G S T : 2284.00 Commission : 13010.00

___________________________________________________________________________________________________
34M-0045934M - (29/08/2019 16:53:50)
0045934M Premium due & Default List for the Month of 09/2019 Page : 3

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
93 345174036 SMT CHHAYA AMIT RATHOR 22/09/2008 165-35 Y 09/2019 36030 1 0.00 36030 1802
SRI PRADHANSINGH RANJEETSINGH CHHA
94 345180895 25/03/2009 165-15 H 09/2019 4852 1 0.00 4852 243
95 345182109 MISS LEELA GHISALAL VERMA 28/03/2009 165-31 H 09/2019 12130 1 0.00 12130 607
96 346830865 MAST SAURABH JAIN [LA] 23/06/2011 165-25 Q 09/2019 1500 1 0.00 1500 75
97 346843302 SRI PRAKASH S/O MOHANLAL PATIDAR 14/09/2012 807-25 Y 09/2019 15679 1 353.00 16032 784
98 346843303 SMT JAYMALA W/O PRAKASH PATIDAR 14/09/2012 807-20 Y 09/2019 19011 1 428.00 19439 951
KU.SUNITA D/O SRI DASHRATHSINGH
99 347962225 28/03/2014 820-20 Q 09/2019 1989 1 45.00 2034 99
100 347962226 TARA ARJUN DHARVE 28/03/2014 814-21 H 09/2019 4870 1 110.00 4980 244
101 347962227 TARA ARJUN DHARVE 28/03/2014 814-16 H 09/2019 5072 1 114.00 5186 254
102 347962229 KALU SINGH BAGHEL 28/03/2014 815-16 H 09/2019 4475 1 101.00 4576 224
103 347974266 SRI MUKESH S/O RAMAJI PANWAR 28/03/2016 833-20 H 09/2019 16578 1 373.00 16951 829

Page Totals : Premium : 122186.00 G S T : 1524.00 Commission : 6112.00

Grand Totals : Premium : 458132.00 G S T : 3985.00 Commission : 25613.00

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34M-0046134M - (29/08/2019 16:53:50)