Life Insurance Corporation of India
NON –RECEIPT OF POLICY –BOND NO :-546907350 D

TO

THE

CHAIR PERSONS

Ref:- NON –RECEIPT OF POLICY –BOND.-

- NO :546907350

DEAR SIR/MADAM,

WITH DUE RESPECT I BEG TO STATE THAT I SHREE Shyama Pada Mondal OPENING A HEALTH INSURANCE POLICY FROM LIFE INSURANCE CORPORATION OF INDIA. I COMPLAIN TO YOU, AGAINST L.I.C. DHANBAD BRANCH—IV (BRANCH MANAGER)

1 .NAME OF THE COMPLAINANT :&&&&&&--SHYAMA PADA MANDAL & SUMA MANDAL RAY

2. ADDRESS OF THE COMPLAINANT :&&&&MAHUDA COAL WASHERY

POST:--MOHUDA

DIST:--DHANBAD

STATE:--(JHARKHAND)

3. E-MAIL/ TELEPHONE/ FAX :&&&&&&&&[email protected]

[email protected]

T.NO:--09934577793

4. WHETHER INDIVIDUAL/COMPANY :&

(a) INDIVIDUAL :&&&&&YES.

(b) COMPANY /OEHER ENTITIES :- X

5 .NAME OF THE INSURANCE COMPANY :&&&&&&&&&&&LIFE INSURANCE CORPORATION -

- OF INDIA.

6. ADDRESS OF THE SERVICING OFFICE /

BRANCH WITH OFFICE CODE (IF AVAILABLE) :&&&&&&-DHANBAD BRANCH-IV

NEAR HOWRAH MOTORS

JORA PHATAK ROAD,

DHANBAD.-826001

BRANCH CODE:--55A

7 (I) POLICY NUMBER / &&&&&&&&&&&&&&&&&&--546907350

(II) PROPOSAL DEPOSIT NUMBER:&&&&&&&&&&&&&-85916

(III) PROPOSAL DEPOSIT DATE:&&&&&&&&&&&&&&-31-03.

(IV) NATURE OF POLICY:&&&&&&&&&&&&&&&&&&-HELTH INSURANCE

(V) PROPOSAL DEPOSIT AMOUNT :&&&&&&&&&&&&Rs.22500.00

(VI) PLAN /Trm / Pterm:&&&&&&&&&&&&&&&&&&&&901/21/21

.

8. NATURE OF COMPLAINT:&&&&&&&&&&&&&&&&-NON –RECEIPT OF POLICY – -BOND.- NO :546907350

9. CLAIM NO:&&&&&&&&&&&&&&&&&&&1st.

SHYAMA PADA MANDAL

&

SUMA MANDAL RAY

MOHUDA COAL WASHERY

POST:--MOHUDA—828305.

DIST:--DHANBAD (JHARKHAND)

T.NO:--09934577793