E-mail : bo_eps1@licindia.com Phone : +91-022-1251 Transaction No. : PR0651450400011314 Date ( Time ): 08/11/2013 ( 18:48:27 ) Servicing Branch : 797 LIC of India, Vaikom Branch Office 1st Floor Municipal Office Complex. Vaikom Vaikom 686141 RENEWAL PREMIUM ACKNOWLEDGEMENT Received with thanks Rs. 18630.30 through Payment Gateway over the Internet from: Smt./Ms./Shri : Vijesh Kuttambally Towards the following Policy No Name Agency Code Plan Term D.O.C. Inst. Prem(Rs) Mode Sum Assured No Of Inst Due Fr Due To Total Premium Late Fee Service Tax Edu Cess Total Amt Branch Next Due 394499860 Vijesh Kuttambally 01263797 90 16 05/10/2009 18,484.00 YLY 3,00,000.00 1 10/13 10/13 18,484.00 146.30 0.00 0.00 18,630.30 797 10/14 Page Total (Rs) 18,484.00 18,484.00 146.30 0.00 0.00 18,630.30 Grand Total (Rs) 18,484.00 18,484.00 146.30 0.00 0.00 18,630.30 RUPEES EIGHTEEN THOUSAND SIX HUNDRED THIRTY AND THIRTY PAISE ONLY Vijesh Kuttambally Ganapatheeyam Eruvatty P O Thalassery, Kannur 670647 Payment Acknowledgement generated through Online Portal on 08-Nov-2013 Time : 18:49:45. Digitally Signed Premium Receipt sent by email This receipt is electronically generated. Page 1of1