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 2022-2023

DATE OF ISSUE :07/09/2023

The following premium has been received for life insurance policies of Soham Ravindra Khole

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 (`) (`)
919699873 28/04/2022 1 B095
28/03/2021 1,917.00 43.12 28/04/2022
Soham Ravindra Khole 28/04/2022 Mly 95K

919699873 28/05/2022 1 B095

28/03/2021 1,917.00 43.12 30/05/2022
Soham Ravindra Khole 28/05/2022 Mly 95K

919699873 28/06/2022 1 B095

28/03/2021 1,917.00 43.12 28/06/2022
Soham Ravindra Khole 28/06/2022 Mly 95K

919699873 28/07/2022 1 B095

28/03/2021 1,917.00 43.12 28/07/2022
Soham Ravindra Khole 28/07/2022 Mly 95K

919699873 28/08/2022 1 B095

28/03/2021 1,917.00 43.12 28/08/2022
Soham Ravindra Khole 28/08/2022 Mly 95K

919699873 28/09/2022 1 B095

28/03/2021 1,917.00 43.12 28/09/2022
Soham Ravindra Khole 28/09/2022 Mly 95K

919699873 28/10/2022 1 B095

28/03/2021 1,917.00 43.12 28/10/2022
Soham Ravindra Khole 28/10/2022 Mly 95K

919699873 28/11/2022 1 B095

28/03/2021 1,917.00 43.12 28/11/2022
Soham Ravindra Khole 28/11/2022 Mly 95K

919699873 28/12/2022 1 B095

28/03/2021 1,917.00 43.12 29/12/2022
Soham Ravindra Khole 28/12/2022 Mly 95K

919699873 28/01/2023 1 B095

28/03/2021 1,917.00 43.12 28/01/2023
Soham Ravindra Khole 28/01/2023 Mly 95K

919699873 28/02/2023 1 B095

28/03/2021 1,917.00 43.12 28/02/2023
Soham Ravindra Khole 28/02/2023 Mly 95K

919699873 28/03/2023 1 B095

28/03/2021 1,917.00 43.12 28/03/2023
Soham Ravindra Khole 28/03/2023 Mly 95K
All the above payments are subject to cheque realisation, wherever applicable.

Total amount received towards premium for the policies listed above is ` 23,004.00 for the financial year
2022-2023.

Total amount received towards Service Tax / GST for the policies listed above is ` 517.44 for the financial year
2022-2023.

* 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.