ĒƵĒćĠđćĉĒčĀ(Premium Receipt)

ăĒĊĒčĂá(Policy No.) SLICL-P-0000735436-0124 ƣđĎïïĒă ĉĒčĀĂá(Receipt No.) : OR0007578227

þđĒĉð(Receipt Date) : 30/06/2024

ąēćđƣđĎĘïĉĂđćíLJïđĂđ(Name & Address) ąēćđčáƠđȭþÿƟđąĊē(Policy Related Information)

Name: Mohammad Rashid Shahriyer Rafsan ąēćđ˝˙ĉþđĒĉð(Comm. Date) 31/12/2023

Address: V/RD - 35.37 East Merul D I T Project
P.O. - Gulshan ăĒĉïɤĂáíĺćĠđĀ(Table & Term) 23 - 3
P.S. - Gulshan
DIST - Dhaka ĒƵĒćĠđćƵĀđĂăȝĒþ(Payment Mode) Monthly
MOB -0014374227087
ëĘöȥ(Agent) SLICL-FA-00201640 ąēćđãáï(Sum Assured) 1,000,000

ĒƵĒćĠđćĒïĒʅ(Total Premium) 25,000

ĒƵĒćĠđćčćːĠĒąąĉýē(Adjustments) öćđĒąąĉýē(Deposit) ĒƵĒćĠđćöćđĉčąŪĘċČĒĎčđą(Record)

čćĒːþĒïĒʅĉčáðƟđ(Adj. Inst.) 1 ĺćđùĒƵĒćĠđć 25,000 ĺćđùƵĀȑĒïĒʅ 7

(Total Premium) (Total Installment Paid)
ĺćđùĒƵĒćĠđć(Total Premium) 25,000
ĺćđùƵĀȑĒƵĒćĠđć(Total 175,000
ĺćđùöćđ 25,000
Premium Paid)
ĒąĊ˘ĒĄ(Late Fees) 0 (Total Deposit)

ăĕąŪąþʗčćĒːþöćđ 0 ƵĘĀĠþđĒĉð Payable Date) 29/06/2024

çȝĖþöćđ 0
(Prev. Adj. Balance) ăĉąþʗĒƵĒćĠđćĺĀĠþđĒĉð 29/07/2024
(Suspense)
ƵĘĀĠùđïđ(Payable Amount) 25,000 (Next Premium Due Date)

ĺćđùùđïđ ïÿđĠ (Total amount in word) Taka Twenty Five Thousand Only ƵĀđĘĂĉāĉý(Payment Purpose) First Year

--------------------- --------------------- ---------------------

ãĒĄĒčĠđĊĒčĊĘćđĎĉ ƵĒþ˰đǘĉ ĆđĉƵđȼïćŪïþŪđ
äăĂđĉćĕĊƟąđĂăĒĊĒčĉçăĘĉçĘɨĒðþþđĒĉĘðƵĘĀĠĒƵĒćĠđĘćĉãĂĔʜĘĊöćđïĖþùđïđäćĉđĺăĘĠĒõëąáçǏĒƵĒćĠđćčćːĠïĘĉăđïđĉĒčĀDžăđúđĘĂđĎĘDZÞĒƵĒćĠđćöćđïĘĉćĕĊƟąđĂąēćđDžôđĒĊĘĠĈđíĠđĉąƟđăđĘĉ
äăĒĂĺĈčĒĀDZđíčĘôþĂþđĺĀĒðĘĠĘõĂëöĂƟäăĂđĘïäȭĒĉïāĂƟąđĀöđĂđĒDZÞƣđĎïĘĀĉëāĉĘĂĉčĘôþĂþđčąŪĀđåäćđĘĀĉĘïãĂĔƵđĒýþïĘĉÞäćĉđäċđïĒĉĆĒąČƟĘþíĒĂāŪđĒĉþčćĘĠĉćĘāƟĒƵĒćĠđćöćđïĘĉ
ăĒĊĒčDžĈÿđĉēĒþôđĊĔĉđðĘąĂÞäăĂđĉăĒĊĒčĉčĄĊĺćĠđĀăĕĒþŪïđćĂđïĒĉÞãĂĔƣĎăĕąŪïĊǘƟïĉĘąĂäăĂđĉăĉąþʗĒƵĒćĠđćþđĒĉĘðƵĘĀĠÞčĘąŪđȑćĺčąđƵĀđĘĂĉćđāƟĘćäăĂđĉčˍĒɳãöŪĂäćđĘĀĉ
ëïđȭïđćƟÞ

ĒƵĒćĠđćĉĒčĀ(Premium Receipt)

ăĒĊĒčĂá(Policy No.) SLICL-P-0000735436-0124 ãĒĄčïĒă ĉĒčĀĂá(Receipt No.) : OR0007578227

Ăđć Mohammad Rashid Shahriyer þđĒĉð(Receipt Date) : 30/06/2024

Rafsan
ąēćđ˝˙ĉþđĒĉð ăĒĉïɤĂáíĺćĠđĀ ąēćđãáï ĒƵĒćĠđćăȝĒþ ĒƵĒćĠđćĒïĒʅ ƵĘĀĠþđĒĉð ƵĀđĘĂĉāĉý

31/12/2023 23 - 3 1000000 Monthly 25000 29/06/2024 First Year

ĒƵĒćĠđćčćːĠĒąąĉýē(Adjustments) öćđĒąąĉýē(Deposit) ĒƵĒćĠđćöćđĉčąŪĘċČĒĎčđą(Record)

čćĒːþĒïĒʅĉčáðƟđ(Adj. Ins.) 1 ĺćđùĒƵĒćĠđć 25000 ĺćđùƵĀȑĒïĒʅ 7

(Total Premium) (Total Installment Paid)
ĺćđùĒƵĒćĠđć(Total Premium) 25000 ĺćđùöćđ 25000
(Total Deposit) ĺćđùƵĀȑĒƵĒćĠđć(Total 175000
ĒąĊ˘ĒĄ(Late Fees) 0 Premium Paid)

çȝĖþöćđ 0 ăĉąþʗĒƵĒćĠđćĺĀĠþđĒĉð 29/07/2024

ăĕąŪąþʗčćĒːþöćđ(Pre. Adj. Bal.) 0 (Suspense) (Next Premium Due Date)

ƵĘĀĠùđïđ(Total Payable) 25000 ëĘöȥ(Agent) SLICL-FA-00201640

--------------------- ---------------------
ƵĒþ˰đǘĉ ĆđĉƵđȼïćŪïþŪđ