Collecting Branch : EPS1 E-mail : bo_eps1@licindia.com Phone : +91-022-1251 Transaction No.

: PR0030489700011213 Date ( Time ): 12/04/2012 ( 13:40:24 )

Servicing Branch : 226 LIC of India,Lucknow City Branch 3rd Floor Halwasiya Market Hazaratganj. Lucknow Lucknow City 226001

RENEWAL PREMIUM RECEIPT

Received with thanks Rs. 5088.00 through Payment Gateway over the Internet from: Smt./Ms./Shri : Sri Vijay Kumar Gupta Towards the following Plan Term D.O.C. 93 Gupta Vk 25 00693289 21/03/1990 Page Total (Rs) Policy No Name Agency Code 280243915 Inst. Prem(Rs) Mode Sum Assured 5,088.00 YLY 1,00,000.00 5,088.00 No Of Inst Due Fr Due To 1 03/12 03/12 Total Premium Late Fee Total Amt 5,088.00 0.00 5,088.00 5,088.00 0.00 5,088.00 5,088.00 0.00 5,088.00 Branch Next Due 226 03/13

Grand Total (Rs)

5,088.00

RUPEES FIVE THOUSAND EIGHTY-EIGHT ONLY Sri Vijay Kumar Gupta M M B 2/8,S B I Colony Sector-P,Aliganj Lucknow 226024 Duplicate receipt generated online through LIC Portal on 12-Apr-2012 Time : 13:44:27

This receipt is electronically generated and is digitally signed.

Signature Not Verified

Digitally signed by REKHA VARSHNEY Date: April 12, 2012 1:44:27 PM IST Reason: Premium Receipt Location: LIC OF INDIA

Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi

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