Collecting Branch : EPS1

E-mail : bo_eps1@licindia.com
Phone : +91-022-1251
Transaction No. : PR1395803500011415

Servicing Branch : 17M

LIC of India, Hissar Br Office - 2
Urban Estate - 2
Behind Commercial Exchange.
Hissar
Hissar-Ii

Date ( Time ): 27/02/2015 ( 16:24:15 )

RENEWAL PREMIUM RECEIPT

Received with thanks Rs. 10284.80 through Payment Gateway over the Internet from:
Smt./Ms./Shri : Ajay Dev Malik
Towards the following
Policy No
Name
Agency Code
176882678

Plan
Term
D.O.C.
149
Adm
78
0097617M
15/01/2009
Page Total (Rs)

Grand Total (Rs)

Inst. Prem(Rs)
Mode
Sum Assured
10,204.00
YLY
2,00,000.00
10,204.00

10,204.00

No Of Inst
Due Fr
Due To
1
01/15
01/15

Total Premium
Late Fee
10,204.00
80.80
10,204.00
80.80
10,204.00
80.80

Service Tax
Edu Cess
Total Amt
0.00
0.00
10,284.80
0.00
0.00
10,284.80
0.00
0.00
10,284.80

Branch
Next Due
17M
01/16

RUPEES TEN THOUSAND TWO HUNDRED EIGHTY-FOUR AND EIGHTY PAISE ONLY
Ajay Dev Malik
S/O Sh Dharam Pal Malik
Kothi No 68 Type 5 Old Mitc Colony
Vidyut Nagar Hisar
100000

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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