6/1/2017 TaxCertificateHome

LifeInsuranceCorporationofIndia
PCMC,NetworkOperatingCenter
1stFloor,JeevanSevaAnnexe
S.V.Road,Santacruz(W)
Mumbai400054

PREMIUMPAIDCERTIFICATEFORTHEYEAR20162017
DATEOFISSUE:01/06/2017

Thisistocertifythatthefollowingpremiumhavebeenreceivedunder
thefollowinglifeinsurancepolicyheldbyGurpreetSinghGill

Name GurpreetSinghGill
PolicyNumber 354920253
Plan 815(NewJeevanAnand)
PolicyTerm 25
PremiumPayingTerm 25
CommencementDate 11/03/2015
InstalmentPremium 1,837.00
ModeOfPremiumPayment MLY
ReferenceCode 35677013

Due NumberOf PremiumAmount Received Collecting

DueTo Status
From Instalments Received Date Branch
04/2016 04/2016 1 1,837.00 16/04/2016 B035 Normal
05/2016 05/2016 1 1,837.00 16/05/2016 B035 Normal
06/2016 06/2016 1 1,837.00 15/06/2016 B035 Normal
Cheque
07/2016 07/2016 1 1,837.00 15/07/2016 B035
Dishonoured
07/2016 08/2016 2 3,674.00 02/08/2016 353 Normal
09/2016 09/2016 1 1,837.00 15/09/2016 B035 Normal
10/2016 10/2016 1 1,837.00 15/10/2016 B035 Normal
11/2016 11/2016 1 1,837.00 18/11/2016 B035 Normal
12/2016 12/2016 1 1,837.00 16/12/2016 B035 Normal
01/2017 01/2017 1 1,837.00 18/01/2017 B035 Normal
02/2017 02/2017 1 1,837.00 16/02/2017 B035 Normal
03/2017 03/2017 1 1,837.00 17/03/2017 B035 Normal

Totalamountreceivedtowardspremiumforthepolicynumber
354920253isRs.22,044.00forthefinancialyear20162017

Thiscertificateiselectronicallygenerated

https://merchant.onlinelic.in/LICMerchant/appmanager/Generic/TaxCertificateHome?selectedValues=354920253|2016|N|WR6BDH 1/1