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Agency Commission - Summary

Branch: 928 RM NO.5 OM VIJAY LAXMI

KUNJAL M SHAH NEAR MALHAR BUNGLOW AYREROAD

03197928-24054 DOMBIVALI EAST

10211946 - 21/09/2017 PIN:400604

Summary of Premium and Commission of 03/2015 (3rd batch) (see annexure-A for details)

Sl.No. Description Premium Commission

1. First Premium and Commission 3,203.00 800.75

2. First Year Premium and Commission 1,985.00 397.00

3. Bonus Commission Payable 0.00 479.10

4. Total Premium and Commission Payable 5,188.00 1,676.85

Payment / Recovery Details (if any) of 03/2015 (3rd batch)

Sl.No. Description Payment Recovery

1. Total First Commission 800.75 0.00

2. Total First Year Commission 397.00 0.00

3. Short Remittance 0.25 0.00

Net Payment 1,198.00

Grand Total: 1,198.00 1,198.00

Commission Bill Voucher Paid on 31/03/2015

Agency Commission - Details (annexure-A)

Name Pol. No. Plan Prem Due Risk Date CBO Adj.Date Premium Commn.NITIN 884841750 820-15 28-03-2015 28-12-2014 EPS1 25/03/2015 1985.00 397.00

SANJAY LODAYA 884906329 815-20 28-03-2015 28-03-2015 928 31/03/2015 3203.00 800.75

928-03197928-03/2015 (3rd batch)-VR-18090 (11/04/2015 15:30:59) Page : 1

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