Collecting Center : A003 Branch Code : CBK1

PCMC, Network Operating Center

BOC No. : 900859 1st Floor, Jeevan Seva Annexe,
S.V.Road, Santacruz(W)
Date ( Time ): 18/02/2018 ( 20:37:42 ) Mumbai - 400 054
Ph. : +91-022-1251
Branch. : 70N e-mail : bo_cbk1@licindia.com

PROPOSAL DEPOSIT RECEIPT

Received with thanks Rs. 15,855.00 (Rupees Fifteen Thousand Eight Hundred Fifty Five Only) from proposer
Shri/Smt/Kum.Narendar towards proposal deposit.

Type of Proposal Deposit : Block

Plan (Plan Description) : 836 (LIC's Jeevan Labh)

Agency Code : 0242670N

Dev. Officer Code : L07100002

Paid by Cash :0.00 Paid by Cheque :15,855.00

Cheque No :103 Cheque Date :15/02/2018

For Life Insurance Corporation of India,

D M SUBRAMANIAN(L07100002)

This receipt is subject to realisation of cheque amount.

Acceptance of this deposit does not make the Corporation liable for acceptance of risk
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BOC No: 900859 Date (Time): 18/02/2018(20:37:42) Branch : 70N

Type of Proposal Deposit : Block Plan : 836 (LIC's Jeevan Labh)

Proposers Short Name : Narendar

Agency Code : 0242670N Agents Name : C.Narendar Kumar

Dev. Officer Code : L07100002

Deposit Amount : Rs.15,855.00 (Rupees Fifteen Thousand Eight Hundred Fifty Five Only)

Paid by Cash :0.00 Paid by Cheque :15,855.00

Cheque No :103 Cheque Date :15/02/2018

Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi