Vasu Gupta

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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 STATEMENT FOR THE YEAR


2021-2022
DATE OF ISSUE: 14/07/2022

The following premia have been received under the following life insurance
policies of Vasu Gupta

No. Of
Premium
Date of Due Instalments Received Collecting Servicing Short
Policy No. Plan Term Due To Amount TotalGst
Commencement From & Payment Date Branch Branch Name
Received
Mode
126989174 814 21 28/12/2015 06/2021 06/2021 1 Quarterly 11,637.00 261.84 26/06/2021 CBK1 326 Vasu
126989174 814 21 28/12/2015 09/2021 09/2021 1 Quarterly 11,637.00 261.84 22/09/2021 CBK1 326 Vasu
126989174 814 21 28/12/2015 12/2021 12/2021 1 Quarterly 11,637.00 261.84 14/12/2021 CBK1 326 Vasu
126989174 814 21 28/12/2015 03/2022 03/2022 1 Quarterly 11,637.00 261.84 23/03/2022 CBK1 326 Vasu
126989175 814 21 28/12/2015 06/2021 06/2021 1 Quarterly 11,637.00 261.84 26/06/2021 CBK1 326 Vasu
126989175 814 21 28/12/2015 09/2021 09/2021 1 Quarterly 11,637.00 261.84 22/09/2021 CBK1 326 Vasu
126989175 814 21 28/12/2015 12/2021 12/2021 1 Quarterly 11,637.00 261.84 14/12/2021 CBK1 326 Vasu
126989175 814 21 28/12/2015 03/2022 03/2022 1 Quarterly 11,637.00 261.84 23/03/2022 CBK1 326 Vasu
126989176 814 21 28/12/2015 06/2021 06/2021 1 Quarterly 5,819.00 130.92 26/06/2021 CBK1 326 Vasu
126989176 814 21 28/12/2015 09/2021 09/2021 1 Quarterly 5,819.00 130.92 22/09/2021 CBK1 326 Vasu
126989176 814 21 28/12/2015 12/2021 12/2021 1 Quarterly 5,819.00 130.92 14/12/2021 CBK1 326 Vasu
126989176 814 21 28/12/2015 03/2022 03/2022 1 Quarterly 5,819.00 130.92 23/03/2022 CBK1 326 Vasu

All the above payments are subject to cheque realisation, wherever applicable.

Total amount received towards premium for the policies listed above is Rs.1,16,372.00 for the financial year 2021-
2022.

Total amount received towards Service Tax / GST for the policies listed above is Rs.2,618.40 for the financial year
2021-2022.

This document is electronically generated, for any queries please contact the servicing branch of respective
policies.

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