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Life Insurance Corporation of India
Name of Treasury:
Sub Treasury, Kondotty
Kerala Sate Government Servant's Policies
Designation of Drawing Oficer:
Medical Officer
( This statement in Duplicate should be completed after varifying the Register of Statement showing deductions on account of Premia towards Life Insurance Corporation of India policies from Insurance Premiums, vide-Annexure C, Appendix II of the Kerala Financial Code Vol II maintained in the Office. One copy to be send along with the Pay Bill and Pay/Salary Bill for August 2009 the other to be retained in the Office along with the copy of the Pay Bill ) Name and Address of Institution :- P.H.C KUZHIMANNA Code No : general1
Sl.No
PEN
1
376427
2
3
4
340332
373609
300528
Premium (Before Rounding off ) Rs.
Policy No.
Month to which the recovery
Anasooya C
791911012
August/2009
310.00
Anasooya C
791938992
August/2009
298.00
Beena C H
791912004
August/2009
351.00
Beena C H
791946021
August/2009
279.00
Beena C H
791912004 Arrear 5/09
August/2009
351.00
Beena C H
791946021 Arrear 5/09
August/2009
279.00
Beena C H
795360194
August/2009
560.00
Mathew KJ
791944557
August/2009
727.00
Mathew KJ
790691520
August/2009
192.00
Mathew KJ
790690212
August/2009
166.00
Pramodan K
791294698
August/2009
120.00
Pramodan K
792688062
August/2009
225.00
Name of Policy Holder
Amount deducted Rs.
1820
Total Three Thousand Eight Hundred Fifty Eight Place: Date :
19/08/2009
Signature of Drawing Officer & Designation(Office Seal) For use of Treasury/ Bank
Name of Treasury/ Bank :
1
608
1085
345 3,858
Remarks (Such as transfers etc.)
Name of Treasury:
Sub Treasury, Kondotty
Kerala Sate Government Servant's Policies
Designation of Drawing Oficer:
Medical Officer
( This statement in Duplicate should be completed after varifying the Register of Statement showing deductions on account of Premia towards Life Insurance Corporation of India policies from Insurance Premiums, vide-Annexure C, Appendix II of the Kerala Financial Code Vol II maintained in the Office. One copy to be send along with the Pay Bill and Pay/Salary Bill for August 2009 the other to be retained in the Office along with the copy of the Pay Bill ) Name and Address of Institution :- P.H.C KUZHIMANNA Code No : general1
Sl.No
PEN
1
376427
2
3
4
340332
373609
300528
Premium (Before Rounding off ) Rs.
Policy No.
Month to which the recovery
Anasooya C
791911012
August/2009
310.00
Anasooya C
791938992
August/2009
298.00
Beena C H
791912004
August/2009
351.00
Beena C H
791946021
August/2009
279.00
Beena C H
791912004 Arrear 5/09
August/2009
351.00
Beena C H
791946021 Arrear 5/09
August/2009
279.00
Beena C H
795360194
August/2009
560.00
Mathew KJ
791944557
August/2009
727.00
Mathew KJ
790691520
August/2009
192.00
Mathew KJ
790690212
August/2009
166.00
Pramodan K
791294698
August/2009
120.00
Pramodan K
792688062
August/2009
225.00
Name of Policy Holder
Amount deducted Rs.
1820
Total Three Thousand Eight Hundred Fifty Eight Place: Date :
19/08/2009
Signature of Drawing Officer & Designation(Office Seal) For use of Treasury/ Bank
Name of Treasury/ Bank :
1
608
1085
345 3,858
Remarks (Such as transfers etc.)
