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Collecting Branch : EPS1

E-mail : bo_eps1@licindia.com
Phone : +91-022-1251

Servicing Branch : 17F


LIC of India, Kalka Brkanch Office
Lower Bazar.
Kalka

Transaction No. : PR1371023900011415


Kalka
133302

Date ( Time ): 22/02/2015 ( 20:08:51 )

RENEWAL PREMIUM RECEIPT


Received with thanks Rs. 25119.00 through Payment Gateway over the Internet from:
Smt./Ms./Shri : Shailesh Kumar Yadav
Towards the following
Policy No
Name
Agency Code
178384863

Plan
Term
D.O.C.
815
Sk Sk
16
0108317F
18/02/2014
Page Total (Rs)

Grand Total (Rs)

Inst. Prem(Rs)
Mode
Sum Assured
24,737.00
YLY
3,00,000.00
24,737.00

24,737.00

No Of Inst
Due Fr
Due To
1
02/15
02/15

Total Premium
Late Fee
24,737.00
0.00
24,737.00
0.00
24,737.00
0.00

Service Tax
Edu Cess
Total Amt
371.00
11.00
25,119.00
371.00
11.00
25,119.00
371.00
11.00
25,119.00

Branch
Next Due
17F
02/16

RUPEES TWENTY-FIVE THOUSAND ONE HUNDRED NINETEEN ONLY


Shailesh Kumar Yadav
S/O Lt Sh Chandgi Ram
Vpo Gurawara, Distt Rewari
Haryana
123035

A.Mu.Shu.2014/3033/C.R.490/M-1 Dated 26/11/2014

This receipt is electronically generated.

Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi


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