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

: PR0056468200011314 Date ( Time ): 22/04/2013 ( 12:42:40 )

Servicing Branch : 75S LIC of India,Karaikkal Br Office II 364 Bharathiyar Street Karaikkal. Karaikal 609602

RENEWAL PREMIUM RECEIPT


Received with thanks Rs. 4668.00 through Payment Gateway over the Internet from: Smt./Ms./Shri : S Jwaala Dhamya La Towards the following Policy No Name Agency Code 753986505
Jwaala Dhamya La S

0019675S Page Total (Rs)

Plan Term D.O.C. 102 20 28/03/2006

Inst. Prem(Rs) Mode Sum Assured 4,668.00 YLY 1,00,000.00 4,668.00

No Of Inst Due Fr Due To 1 03/13 03/13

Total Premium Late Fee 4,668.00 0.00 4,668.00 0.00 4,668.00 0.00

Service Tax Edu Cess Total Amt 0.00 0.00 4,668.00 0.00 0.00 4,668.00 0.00 0.00 4,668.00

Branch Next Due 75S 03/14

Grand Total (Rs)

4,668.00

RUPEES FOUR THOUSAND SIX HUNDRED SIXTY-EIGHT ONLY S Jwaala Dhamya La No:3,Thirughanasambanthar St., Viswanathan Nagar, Muthaiyalpet, Puducherry 605003 This receipt is electronically generated.

Signature Not Verified


Digitally signed by REKHA VARSHNEY Date: April 22, 2013 12:42:40 PM IST Reason: Premium Receipt Location: LIC OF INDIA

Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi


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