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District Insurance Office : East Godavari
Financial Year : 2014-2015

Policy No. : 2419898

Employee Name : P. Lalitha Kumari

Designation : Os

S.No. Month Year Premium Amount (Rs.) Loan Amount (Rs.)

1 April 2014 250 0
2 May 2014 750 0

3 June 2014 0 0
4 July 2014 500 0

5 August 2014 0 0

6 September 2014 250 0

7 October 2014 250 0

8 November 2014 250 0

9 December 2014 250 0

10 January 2015 250 0

11 February 2015 250 0

12 March 2015 250 0

Total credits received during the year : 3,250 0

Opening Balance : 0
Current Year Premium Amount : 3,250
Total Balance : 3,250
DISTRICT INSURANCE OFFICER
East Godavari

Note: This is a Computer Generated Report.

The credits shown are only to the extent of Schedules received from DTOs and posted.

1. This Statement of account is subject to E&OE

2. The subscriber is requested to satisfy himself/herself as to the correctness of the statement and to bring errors,
if any, to the notice of this office within one month from the date of issue with the details of Vr.no.,amount of
voucher,copy of schedule (voucher) under attestation by the DDO concerned.
3. Please quote correct Policy Number in the Schedule (Voucher) and avoid missing credits.
4. In case of transfer, the information may please be informed to District Insurance Office.
5. Proposal Form is compulsory every time whenever the APGLI subscription is increased to obtain additional
policies.
6. Proposal forms have to be submitted before (53) years of age to obtain first or subsequent policies otherwise,
excess premium, if any paid, will be treated as unauthorized amount.

Report Date : 19/07/2018

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