Branch: 477 JHOLA SAHI NEW COLONY

KEDARNATH SAHOO. NEAR CONTROL

SHOP.BUXIBAZAR
Agent : LIC00353477 CUTTACK,ODISHA
Leader :9999999 PIN:753001

00353477 Premium due & Default List for the Month of 12/2019 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
1 584714469 BIJAYA LAXMI BISWAL @ RAY 26/10/2002 014-20 Q 07/2019 267 2 0.00 534 27
2 584714481 KABIRAJ PRADHAN 28/10/2002 075-20 Q 07/2019 652 2 0.00 1304 78
3 585525654 SHASHIKANT MAHARANA 07/07/2004 075-20 Y 07/2019 3498 1 0.00 3498 210
4 588510370 SANJAY KUMAR SAHOO(LA) 27/01/2009 179-16 Q 07/2019 696 2 0.00 1392 70
5 589556447 NABIN KUMAR SAHOO 23/07/2007 179-20 Y 07/2019 2380 1 0.00 2380 119
6 597848315 PRAJNA PARAMITA NAYAK 07/07/2010 179-20 Q 07/2019 1541 2 0.00 3082 154
7 598372746 BIJAYA MULIA 14/07/2011 179-16 Q 07/2019 1520 2 0.00 3040 152
8 598372819 SATYA PRAKASH PANIGRAHI 20/07/2011 075-20 Q 07/2019 3205 2 0.00 6410 385
9 598380934 SANJAY KUMAR SAHOO 10/10/2012 179-12 Q 07/2019 1812 2 0.00 3624 181
10 583328992 BIBHUTI BHUSAN MUDULI. 26/11/2001 075-20 Q 08/2019 655 2 0.00 1310 79
11 585526139 MR.BUDHADEV PARIDA 25/08/2004 075-20 Y 08/2019 3236 1 0.00 3236 194
12 586330681 DHARMAPADA ROUT 28/05/2006 075-20 Q 08/2019 832 2 0.00 1664 100
13 586335815 ASIS NAYAK 06/02/2007 179-20 Q 08/2019 724 2 0.00 1448 72
14 588515652 SURESH RANA 28/08/2009 014-11 Q 08/2019 1601 2 0.00 3202 160
15 599089360 ARUNA PRAVA PATTANAIK 26/08/2013 179-16 Y 08/2019 4499 1 0.00 4499 225
16 599778955 SUPARAG MISHRA 10/02/2016 836-21 Q 08/2019 20344 2 916.00 41604 2034
17 828802311 CHANDRABHANU DAS 28/08/2018 827-20 Q 08/2019 942 2 42.00 1926 104
18 828803074 PRAVASH RANJAN TRIPATHY 17/11/2018 836-16 Q 08/2019 4747 2 427.00 9921 1305
19 828803075 SMRUTI RANJAN TRIPATHY 17/11/2018 836-25 Q 08/2019 3555 2 320.00 7430 1155
20 846612806 RASHMI RANJAN PANIGRAHI 28/08/2017 841-16 Q 08/2019 2295 2 103.00 4693 344
21 559393758 PRITAM OJHA 28/03/2016 814-21 Q 09/2019 1514 2 68.00 3096 151
22 559397206 SANUJA KUMAR SAHOO 28/09/2016 836-21 Y 09/2019 11148 1 251.00 11399 557
23 583329312 SRI BHASAKAR MAHARANA 05/12/2001 091-20 Q 09/2019 326 2 0.00 652 33
24 584715393 CHITTARANJAN PRUSTY 14/12/2002 093-25 Q 09/2019 536 2 0.00 1072 64
25 585529574 OSCB,LINKRD.CTC 28/03/2005 091-16 Q 09/2019 505 2 0.00 1010 51
26 586328469 ABHAYA PRASAD PANDA 28/03/2006 174-20 Q 09/2019 562 2 0.00 1124 56
27 586339158 SANATAN OJHA 28/03/2007 179-16 Q 09/2019 901 2 0.00 1802 90
28 589555870 RAMA CHANDRA MAHARANA 13/06/2007 179-20 Q 09/2019 611 2 0.00 1222 61
29 589557923 DHARMAPADA ROUT 12/09/2007 179-16 Q 09/2019 725 2 0.00 1450 73
30 589567191 SANTANU PRASAD SINGH 15/09/2008 179-20 Y 09/2019 3861 1 0.00 3861 193
31 589567342 BISWAJEET MAHARANA 26/09/2008 179-16 Q 09/2019 729 2 0.00 1458 73
32 597853623 CHITTA RANJAN PRUSTY 04/03/2011 149-68 Q 09/2019 1909 2 0.00 3818 191
33 599776947 SANJAYA KUMAR SAHOO 03/09/2015 814-12 Y 09/2019 21775 1 490.00 22265 1089
34 599777192 BRUNDABAN BAG 28/09/2015 820-20 H 09/2019 10740 1 242.00 10982 537
35 828802580 PRIYANSHI MOHAPATRA(LA) 27/09/2018 834-24 H 09/2019 4574 1 103.00 4677 343
36 828802653 LAXMI PRIYA MAHARANA 28/09/2018 836-21 H 09/2019 5715 1 129.00 5844 429
37 585526838 SANUJA KUMAR SAHOO 27/10/2004 075-20 Q 10/2019 831 1 0.00 831 50
38 585526989 SURESH YADAV 15/10/2004 156-20 Y 10/2019 4398 1 0.00 4398 220
39 588515221 SUBASH OJHA 28/07/2009 091-20 Q 10/2019 534 1 0.00 534 27
40 589555092 ANIL SAHA 24/04/2007 179-16 Q 10/2019 1314 1 0.00 1314 66
41 589558412 DEEPAK DEVKAR. 03/10/2007 179-20 Y 10/2019 13097 1 0.00 13097 655
42 589566153 ABHAYA PRASAD PANDA 22/07/2008 179-20 Q 10/2019 630 1 0.00 630 32

Page Totals : Premium : 145936.00 G S T : 3091.00 Commission : 12189.00

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00353477 Premium due & Default List for the Month of 12/2019 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 589567752 RABINDRA NATH BARIK 17/10/2008 179-16 Q 10/2019 817 1 0.00 817 41
44 599768962 ANUCHHAYA MAHARANA 24/01/2014 814-15 Q 10/2019 2867 1 65.00 2932 143
45 599775533 ASIT KUMAR PRUSTY 22/04/2015 821-25 Q 10/2019 1549 1 35.00 1584 77
46 599776371 SANUJA KUMAR SAHOO 15/07/2015 827-10 Q 10/2019 1633 1 37.00 1670 61
47 828803877 SANDIP MAHAPATRA 17/01/2019 836-21 Q 10/2019 2800 1 126.00 2926 700
48 559395265 GANGADHAR PRUSTY 28/05/2016 836-16 H 11/2019 8674 1 195.00 8869 434
49 580282495 SHRI KEDARNATH SAHOO 25/05/1993 014-30 Q 11/2019 211 1 0.00 211 11
50 580816726 RANJAN KUMAR NAYAK 16/08/1996 093-25 Q 11/2019 277 1 0.00 277 17
51 583328878 RADHASHYAM MOHANTY 10/11/2001 103-20 Q 11/2019 505 1 0.00 505 30
52 583328881 PUSPALATA SETHI 09/11/2001 128-20 Y 11/2019 3552 1 0.00 3552 213
53 585521654 MR.NIRANJAN MANTRI 25/11/2003 103-20 Q 11/2019 1444 1 0.00 1444 87
54 585527749 SANGEETA MISHRA 28/11/2004 159-24 Y 11/2019 8657 1 0.00 8657 433
55 586322314 PUSPA GUPTA 12/08/2005 014-21 Q 11/2019 690 1 0.00 690 35
56 586323796 SASHIKANTA SATAPATHY 10/11/2005 174-20 Y 11/2019 6824 1 0.00 6824 341
57 586323966 RADHASHYAM MOHANTY 25/11/2005 174-20 Y 11/2019 3966 1 0.00 3966 198
58 586331604 SAROJ KUMAR BEHERA. 28/07/2006 178-75 M 11/2019 1101 2 0.00 2202 110
59 586331987 RANJAN KUMAR NAYAK 17/08/2006 178-63 Q 11/2019 3203 1 0.00 3203 160
60 586333854 BIJAY MULIA 27/11/2006 179-20 Q 11/2019 1273 1 0.00 1273 64
61 588510930 MOHAMMED HANIF 17/02/2009 091-12 Q 11/2019 691 1 0.00 691 35
62 588515344 RITUPARNA NAYAK (L.A.) 14/08/2009 102-21 Q 11/2019 5766 1 0.00 5766 288
63 588517256 SRI SANTOSH KUMAR BEHERA 19/11/2009 090-12 Y 11/2019 9242 1 0.00 9242 462
64 588519121 RATIKANTA OJHA 06/02/2010 179-20 Q 11/2019 1135 1 0.00 1135 57
65 589564228 PRADEEP KUMAR CHOUDHURY 28/02/2008 179-16 Q 11/2019 944 1 0.00 944 47
66 589569201 MISS. LEENA MOHAPATRA. 28/11/2008 165-15 H 11/2019 2426 1 0.00 2426 121
67 597849379 MANORAMA PANDA 28/08/2010 179-20 Q 11/2019 622 1 0.00 622 31
68 598372075 PUSPANJALI CHOUDHURY 10/05/2011 103-18 Q 11/2019 781 1 0.00 781 47
69 598374660 SUBHASIS PRUSTY 12/11/2011 179-20 Q 11/2019 995 1 0.00 995 50
70 598374661 AKSHAY KUMAR SAHOO 12/11/2011 179-20 Q 11/2019 957 1 0.00 957 48
71 598375186 UDEEPTA MOHANTY 28/11/2011 184-17 Y 11/2019 76163 1 0.00 76163 3808
72 599772073 SUBHENDU PRUSTY 05/11/2014 815-21 Y 11/2019 5426 1 122.00 5548 271
73 599772329 RASHMITA BHATTA 26/11/2014 815-21 Y 11/2019 10474 1 236.00 10710 524
74 599773558 NANDA KISHOR DAS 23/02/2015 827-20 Q 11/2019 1006 1 23.00 1029 38
75 599776614 MAHENDRA KUMAR BEHERA 04/08/2015 814-20 Q 11/2019 1889 1 43.00 1932 94
76 599776862 INDULATA SAHOO 28/08/2015 814-15 Q 11/2019 1937 1 44.00 1981 97
77 599777966 SAISHRADHA BHATTA 28/11/2015 834-25 Y 11/2019 13206 1 297.00 13503 660
78 828802171 TAPAS GHOSE 22/08/2018 836-16 Q 11/2019 4712 1 106.00 4818 353
79 828803288 BIKASH RANJAN SAHOO 28/11/2018 836-21 Q 11/2019 6844 1 154.00 6998 513
80 828804550 L. RAMA RAO 25/02/2019 814-18 Q 11/2019 1522 1 69.00 1591 381
81 846607655 AYUSH PRUSTY 28/11/2016 834-21 H 11/2019 3038 1 68.00 3106 152
82 846612585 MANOJ KUMAR MOHAPATRA 28/08/2017 841-24 Q 11/2019 1560 1 35.00 1595 117
83 846613648 PRAKASH KUMAR SAHOO 22/11/2017 814-12 H 11/2019 4525 1 102.00 4627 339
84 846613653 KEDAR PRUSTY 18/11/2017 836-16 Y 11/2019 27718 1 624.00 28342 2079
85 559393757 GOBINDA KUMAR SAHOO 28/03/2016 814-15 Q 12/2019 1827 1 41.00 1868 91
86 559396912 SIBANSH NAYAK 08/09/2016 832-25 Q 12/2019 1216 1 27.00 1243 61
87 559397344 SUMAN LATA RAM 28/09/2016 820-20 Q 12/2019 2271 1 51.00 2322 114
88 580815761 KEDARNATH SAHOO 28/03/1996 111-29 Q 12/2019 309 1 0.00 309 19
89 580820750 SRI ROHIT KUMAR DAS 17/03/1998 111-25 Q 12/2019 390 1 0.00 390 23
90 580820751 SRI RAMESH PRASAD PATI 17/03/1998 111-25 Q 12/2019 341 1 0.00 341 20
91 580820757 SRI JITENDRA KUMAR BEHERA 20/03/1998 093-25 Q 12/2019 335 1 0.00 335 20
92 583322308 SK.TASADUQUE HODA. 20/03/2000 075-20 Q 12/2019 1736 1 0.00 1736 104

Page Totals : Premium : 242047.00 G S T : 2500.00 Commission : 14219.00

___________________________________________________________________________________________________
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00353477 Premium due & Default List for the Month of 12/2019 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 583322603 AKHAYA KUMAR NANDA. 28/03/2000 075-20 Q 12/2019 440 1 0.00 440 26
94 583323639 SASANKA BHUYAN. 09/06/2000 103-20 Q 12/2019 377 1 0.00 377 23
95 583325185 DEBENDRA PRASAD BHAGAT. 12/12/2000 103-20 Q 12/2019 1506 1 0.00 1506 90
96 583326307 SAURYA PRAKASH DAS. 26/03/2001 111-20 Q 12/2019 314 1 0.00 314 19
97 583326308 JOYPRAKASH DAS. 26/03/2001 111-20 Q 12/2019 312 1 0.00 312 19
98 583326701 BANSHIDHAR MAHARANA. 28/03/2001 075-20 Q 12/2019 671 1 0.00 671 40
99 583326740 JENAMANI RAMAKANTA CHOUDHURY. 28/03/2001 075-20 Q 12/2019 674 1 0.00 674 40
100 583327865 SUSANTA KUMAR NAYAK. 20/06/2001 111-25 Q 12/2019 390 1 0.00 390 23
101 583329426 RENUBALA DASH 21/12/2001 128-20 Y 12/2019 3627 1 0.00 3627 218
102 583329437 RITA MOHANTY 26/12/2001 128-20 Y 12/2019 7255 1 0.00 7255 435
103 583329484 RANJITA PRUSTY @SAHOO 28/12/2001 128-20 Y 12/2019 2878 1 0.00 2878 173
104 583329676 PRAVASINI DAS @ KANUNGO 28/12/2001 128-20 Y 12/2019 2930 1 0.00 2930 176
105 583329677 DEBAJANI ACHARYA 28/12/2001 128-20 Y 12/2019 2910 1 0.00 2910 175
106 583329680 SAILABALA SWAIN @ PARIDA 28/12/2001 128-20 Y 12/2019 3240 1 0.00 3240 194
107 583329681 SOUVAGINI DASH @ TRIPATHY 28/12/2001 128-20 Y 12/2019 3010 1 0.00 3010 181
108 584711906 MAHENDRA KUMAR SETHI 28/03/2002 103-19 Q 12/2019 385 1 0.00 385 23
109 584712965 BIKASH PARIDA(L.A) 12/06/2002 102-18 Q 12/2019 370 1 0.00 370 19
110 584716836 SANGEETA MISHRA 28/12/2002 103-21 Y 12/2019 2892 1 0.00 2892 174
111 585520558 PRAMOD PRASAD SINGH 15/09/2003 093-25 Q 12/2019 659 1 0.00 659 40
112 585522195 ARUN KUMAR DASH 28/12/2003 014-25 Q 12/2019 566 1 0.00 566 28
113 585525561 SUDHANSU SEKHAR NAYAK(L.A) 28/06/2004 159-26 Q 12/2019 1984 1 0.00 1984 99
114 585527365 THE URBAN CO-OP BANK LTD 10/12/2004 075-20 Y 12/2019 3229 1 0.00 3229 194
ISHA SAMAL(L.A)SUPRIYA PRUSTY(LP)
115 585527748 28/12/2004 159-25 Y 12/2019 15829 1 0.00 15829 791
116 585527957 RANJAN KUMAR SAHOO 28/12/2004 093-25 Q 12/2019 677 1 0.00 677 41
117 585529506 RADHASHYAM MOHANTY 28/03/2005 103-25 Q 12/2019 636 1 0.00 636 38
118 585529533 SUJAY KUMAR SWAIN 11/03/2005 075-20 Q 12/2019 838 1 0.00 838 50
119 586322997 ADITYA KUMAR MISHRA 20/09/2005 159-26 Q 12/2019 1922 1 0.00 1922 96
120 586326585 LAXMIDHAR SWAIN 17/03/2006 174-20 Q 12/2019 1453 1 0.00 1453 73
121 586326691 DAMODAR GOCHHI 20/03/2006 174-20 Q 12/2019 601 1 0.00 601 30
122 586326694 HARAPRIYA BARIK 20/03/2006 174-20 Q 12/2019 444 1 0.00 444 22
123 586326752 MR.BIJAY KUMAR BISWAL 21/03/2006 174-16 Q 12/2019 751 1 0.00 751 38
124 586328470 DHADESWAR OJHA 28/03/2006 174-16 Q 12/2019 692 1 0.00 692 35
125 586328471 SUJIT KUMAR PANDA 28/03/2006 174-16 Q 12/2019 1291 1 0.00 1291 65
126 586328472 PRASHANT KUMAR NAYAK 28/03/2006 174-20 Q 12/2019 970 1 0.00 970 49
127 586328474 BISWAJIT NAYAK 28/03/2006 174-20 Q 12/2019 970 1 0.00 970 49
128 586331122 MANAS RANJAN DAS 28/06/2006 093-25 Q 12/2019 677 1 0.00 677 41
129 586332583 ASHOK KUMAR MISHRA 14/09/2006 178-53 Q 12/2019 2805 1 0.00 2805 140
130 586334357 DEEPAK DEVKAR. 15/12/2006 179-16 Y 12/2019 11322 1 0.00 11322 566
131 586334511 SHAKTI PRASAD MOHAPATRA 26/12/2006 179-20 Y 12/2019 5815 1 0.00 5815 291
132 586334512 JAGANNATH KISKU 26/12/2006 179-16 Y 12/2019 5088 1 0.00 5088 254
133 586339159 CHAITANYA CHARAN PARIDA 28/03/2007 179-20 Q 12/2019 1579 1 0.00 1579 79
134 588513064 MADAN BISWAL 28/03/2009 179-16 Q 12/2019 725 1 0.00 725 36
135 588513066 PRASANTA KUMAR NAYAK 28/03/2009 165-15 Q 12/2019 766 1 0.00 766 38
136 588517817 GANGA DHAR PRUSTY 19/12/2009 179-16 Q 12/2019 2841 1 0.00 2841 142
137 588517818 KIRAN KUMAR MAHARANA 19/12/2009 179-16 Q 12/2019 1564 1 0.00 1564 78
138 588518198 CHITTA RANJAN MOHAPATRA 28/12/2009 179-16 H 12/2019 3171 1 0.00 3171 159
139 589555836 KRISHNA BAHADUR 11/06/2007 179-16 Q 12/2019 1019 1 0.00 1019 51
140 589555998 DEBENDRA SAHOO 25/06/2007 179-20 Q 12/2019 935 1 0.00 935 47
141 589559775 MANOJ KUMAR SAHOO 19/12/2007 179-20 Q 12/2019 926 1 0.00 926 46
142 589559974 JAGANNATH MISHRA 28/12/2007 179-20 Y 12/2019 10735 1 0.00 10735 537

Page Totals : Premium : 117661.00 G S T : 0.00 Commission : 6291.00

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00353477 Premium due & Default List for the Month of 12/2019 Page : 4

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
143 589567406 SITA RANI SINGH 28/09/2008 165-15 Q 12/2019 766 1 0.00 766 38
144 589568850 GANJO YADAV 08/12/2008 179-12 H 12/2019 1799 1 0.00 1799 90
145 589569202 CHITTA RANJAN MOHAPATRA 28/12/2008 179-16 H 12/2019 2350 1 0.00 2350 118
146 589569294 RABI SHANKAR MANDAL 28/12/2008 165-15 Q 12/2019 786 1 0.00 786 39
147 589569541 BIJAY LAXMI BISOI 28/12/2008 179-12 Y 12/2019 6250 1 0.00 6250 313
148 589569543 SIBENDRA BISOI 28/12/2008 179-12 Y 12/2019 28015 1 0.00 28015 1401
149 597847869 NAGEN KUMAR RAY 07/06/2010 179-12 Q 12/2019 3264 1 0.00 3264 163
150 597847891 SANGEETA MISHRA 10/06/2010 179-16 Q 12/2019 994 1 0.00 994 50
151 597848054 KRUTIBAS PANIGRAHI 25/06/2010 179-20 Q 12/2019 1805 1 0.00 1805 90
152 597849604 DEBARAJ SAHU 18/09/2010 179-16 Q 12/2019 994 1 0.00 994 50
153 597851356 NARAYAN SENAPATI 10/12/2010 179-16 Q 12/2019 2502 1 0.00 2502 125
154 597851564 JAYANTA KUMAR SAHOO 20/12/2010 179-20 Y 12/2019 4181 1 0.00 4181 209
155 597851622 RAMESH CHANDRA NAYAK 23/12/2010 179-16 Y 12/2019 3262 1 0.00 3262 163
156 597854274 PRATAP MOHARANA 26/03/2011 091-16 Q 12/2019 993 1 0.00 993 50
157 598371405 MANASI CHOUDHURY 28/03/2011 179-20 Q 12/2019 689 1 0.00 689 34
158 598372375 RANJIT KUMAR SETHI 02/06/2011 133-16 H 12/2019 5555 1 0.00 5555 278
159 598375251 PRADEEP KUMAR SAHOO 12/12/2011 089-17 Y 12/2019 7360 1 0.00 7360 368
160 598375614 KANHU CHARAN SWAIN 28/12/2011 014-15 Q 12/2019 1065 1 0.00 1065 53
161 598378165 ANIL KUMAR PARIDA 28/03/2012 165-16 Q 12/2019 1531 1 0.00 1531 77
162 598378166 JITENDRA BEHERA 28/03/2012 179-16 Q 12/2019 719 1 0.00 719 36
163 598379606 MANAS RANJAN DAS 28/06/2012 075-20 Q 12/2019 3243 1 0.00 3243 195
164 598380704 MINATI MAHARANA 26/09/2012 165-15 Q 12/2019 766 1 0.00 766 38
165 599083971 ARATI NAIK 08/12/2012 179-12 Q 12/2019 1565 1 0.00 1565 78
166 599084530 AKSHYA KUMAR MAHARANA 28/12/2012 149-69 Q 12/2019 1284 1 0.00 1284 64
167 599087278 TASLIMA NURE NAJAR 28/03/2013 165-15 Q 12/2019 1528 1 0.00 1528 76
168 599088671 MADAN MOHAN ROUT 28/06/2013 179-16 Q 12/2019 944 1 0.00 944 47
169 599089637 RUKSAR BEGUM 03/09/2013 179-16 Q 12/2019 717 1 0.00 717 36
170 599090850 PRADEEP KUMAR CHOUDHURY 28/09/2013 179-16 Q 12/2019 1082 1 0.00 1082 54
171 599090853 DIBYA RANJAN RANA 28/09/2013 014-25 Q 12/2019 1006 1 0.00 1006 50
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176 599768144 NALINI TRIPATHY 28/12/2013 165-15 Q 12/2019 766 1 0.00 766 38
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184 599768403 SANGEETA SAH 28/12/2013 149-71 Y 12/2019 31987 1 0.00 31987 1599
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186 599768636 ARPITA MOHANTY 28/12/2013 102-15 H 12/2019 3483 1 0.00 3483 174
187 599769533 SANTOSH KUMAR SENAPATI 24/03/2014 815-21 Q 12/2019 1465 1 33.00 1498 73
188 599771355 GANGADHAR PRUSTY 03/09/2014 814-12 Q 12/2019 5587 1 126.00 5713 279
189 599771436 SATYA PRAKASH MOHANTY 15/09/2014 814-17 Q 12/2019 1541 1 35.00 1576 77
190 599771592 UDAYA NARAYAN BEHERA 28/09/2014 814-12 Q 12/2019 3008 1 68.00 3076 150
191 599772600 NEHA SAHA 05/12/2014 815-15 Y 12/2019 11697 1 263.00 11960 585
192 599772755 MEETA ROUT 26/12/2014 821-25 Y 12/2019 16691 1 376.00 17067 835

Page Totals : Premium : 316782.00 G S T : 901.00 Commission : 15870.00

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00353477 Premium due & Default List for the Month of 12/2019 Page : 5

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
193 599773211 PRANAB BASTIA 28/12/2014 815-23 Y 12/2019 48666 1 1095.00 49761 2433
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198 599776957 RANJAN KUMAR BISWAL 07/09/2015 827-12 Q 12/2019 1328 1 30.00 1358 50
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206 846607797 SK. IDRISH 17/12/2016 841-24 Q 12/2019 1722 1 39.00 1761 86
207 846607959 PRAVASINI DAS 28/12/2016 814-12 Y 12/2019 10125 1 228.00 10353 506
208 846608086 AMARNATH SAHOO 28/12/2016 836-21 Q 12/2019 2787 1 63.00 2850 139
209 846610444 RAKESH KUMAR SAHU 28/03/2017 836-25 Q 12/2019 2984 1 67.00 3051 224
210 846611721 KIRAN KUMAR MAHARANA 12/06/2017 814-12 Q 12/2019 2842 1 64.00 2906 213
211 846611724 KANAKA LATA MAHARANA 13/06/2017 844-16 H 12/2019 3304 1 74.00 3378 248
212 846612957 JYOTSNA RANI BEHERA 13/09/2017 814-12 Q 12/2019 2450 1 55.00 2505 184
213 846614062 SASHIKANTA MISHRA 19/12/2017 830-12 M 12/2019 10945 1 246.00 11191 547
214 846614081 ANIRUDHA ROUT 27/12/2017 814-21 Q 12/2019 2562 1 58.00 2620 192
215 846617529 NAMITA BEHERA 14/06/2018 836-16 H 12/2019 9332 1 210.00 9542 700

Page Totals : Premium : 186339.00 G S T : 4296.00 Commission : 11722.00

Grand Totals : Premium : 1008765.00 G S T : 10788.00 Commission : 60291.00

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