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

: PR0575662600011314 Date ( Time ): 16/10/2013 ( 19:06:03 )

Servicing Branch : 924 LIC of India, Bombay B O Andheri (E) 924 D J House Wilson Pen Compond Old Nagardas Rd Near Andehri Subway Andheri East Mumbai Mumbai Maharashtra 400069

RENEWAL PREMIUM ACKNOWLEDGEMENT


Received with thanks Rs. 2120.00 through Payment Gateway over the Internet from: Smt./Ms./Shri : Mr.Sandeep Gajanan Bobhate Towards the following Policy No Name Agency Code 894705227
Bobhate S.G.

01594924 Page Total (Rs)

Plan Term D.O.C. 149 76 26/04/2011

Inst. Prem(Rs) Mode Sum Assured 2,120.00 HLY 1,00,000.00 2,120.00

No Of Inst Due Fr Due To 1 10/13 10/13

Total Premium Late Fee 2,120.00 0.00 2,120.00 0.00 2,120.00 0.00

Service Tax Edu Cess Total Amt 0.00 0.00 2,120.00 0.00 0.00 2,120.00 0.00 0.00 2,120.00

Branch Next Due 924 04/14

Grand Total (Rs)

2,120.00

RUPEES TWO THOUSAND ONE HUNDRED TWENTY ONLY Mr.Sandeep Gajanan Bobhate 19/A-14, Shivashram Estate Chawl, Nardas Nagar, Tembhipada Road, Bhandup (W), Mumbai. 400078 Payment Acknowledgement generated through Online Portal on 28-Dec-2013 Time : 17:30:48. Digitally Signed Premium Receipt sent by email

This receipt is electronically generated.

Signature Not Verified


Digitally signed by Rekha Varshney Date: December 28, 2013 5:30:48 PM IST Reason: Premium Receipt Location: LIC OF INDIA

Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi


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