8/17/2019 Declaration From Spouse

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DECLARATION REGARDING LIC POLICY / PPF

I,………………………………………………….. (Name of the Spouse), do hereby confirm that

the following LIC olicy ! " which is in my name ha#e being paid by my husband ! wife

………………………….. (Name of the $mployee) in the "inancial %ear &'*+.

Sl. No. olicy No. !" ccount No.

-ate of ayment mount (IN)

/otal

I further confirm that I do not claim the abo#e said policy ! " for Income /a0 e0emption in the

"inancial %ear &'*+

 /he abo#e information is true and correct to the best of my 1nowledge and I shall be personally

responsible and liable if the same is found to be incorrect.

Signature.

 Name 2 Spouse Name

N 2 Spouse N

lace 2

-ate2