PREMIUM PAID CERTIFICATE FOR THE YEAR 2022-2023
L.I.C. OF INDIA BRANCH : Q088 DATE : 12/01/2023
This is to certify that the following payments have been made under
life insurance policies held by Mr/Ms. SHEELA ROSY JACOB
Holder of Permanent Account Number :
Customer Identification Number 005120817226
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Policy no Due Inst.Prem Comm.Date Mode Plan-Term-PPT Date of Pay.
Policy Holder's Name Addl.Prem Crit.Ill.Prm. Chq.ind. Remarks
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885227460 6/2022 4594.00 24/09/2013 QLY 165-20-20 13/07/2022
SHEELA ROSY JACOB 0.00 0.00 SRV.BR 88M CASH
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885227460 9/2022 4594.00 24/09/2013 QLY 165-20-20 27/08/2022
SHEELA ROSY JACOB 0.00 0.00 SRV.BR 88M CASH
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885227460 12/2022 4594.00 24/09/2013 QLY 165-20-20 02/01/2023
SHEELA ROSY JACOB 0.00 0.00 SERV.BRANCH 88M
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Total amount paid towards premium is Rs. 13782.00 for fin. year 2022-2023
PREPD. BY:443111 P.CHIEF/SR/BRANCH MANAGER
PRINTED AT :Q088
