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

: PR0349304600011213 Date ( Time ): 31/08/2012 ( 19:56:54 )

Servicing Branch : 739 LIC of India,Bhadravathi Branch LIC Building Near Railway Under Bridge Umblebyle Road P.B.No.109 Bhadravathi Bhadrawathi 577301

RENEWAL PREMIUM RECEIPT

Received with thanks Rs. 14152.00 through Payment Gateway over the Internet from: Smt./Ms./Shri : Bhagyalakshmi.C Towards the following Policy No Name Agency Code 629483048
Bhagyalakshmi C

01074739 Page Total (Rs)

Plan Term D.O.C. 149 76 06/08/2010

Inst. Prem(Rs) Mode Sum Assured 14,152.00 YLY 2,00,000.00 14,152.00

No Of Inst Due Fr Due To 1 08/12 08/12

Total Premium Late Fee 14,152.00 0.00 14,152.00 0.00 14,152.00 0.00

Service Tax Edu Cess Total Amt 0.00 0.00 14,152.00 0.00 0.00 14,152.00 0.00 0.00 14,152.00

Branch Next Due 739 08/13

Grand Total (Rs)

14,152.00

RUPEES FOURTEEN THOUSAND ONE HUNDRED FIFTY-TWO ONLY Bhagyalakshmi.C D/O Chidanandaiah.M.G H.No.602/A,I Main, Vi Cross K.B.Extention, Davanagere-2 100000 Mudrank :A.Mu.Sh.2012/45/CR 28/M-1 Dated 13/07/2012

This receipt is electronically generated.

Signature Not Verified

Digitally signed by REKHA VARSHNEY Date: August 31, 2012 7:56:54 PM IST Reason: Premium Receipt Location: LIC OF INDIA

Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi

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