Collecting Branch : EPS1

E-mail : bo_eps1@licindia.com
Phone : +91-022-1251
Transaction No. : PR1274620000011516
Date ( Time ): 14/01/2016 ( 20:36:21 )

Servicing Branch : 370

LIC of India, Shahdol Branch Office
Nr Rajendra Talkies
Main Rd.
Shahdol M P
Shahdol
Madhya Pradesh 484001

RENEWAL PREMIUM ACKNOWLEDGEMENT

Received with thanks Rs. 15012.00 through Payment Gateway over the Internet from:
Smt./Ms./Shri : Ku. Shweta Shukla
Towards the following
Policy No
Name
Agency Code
207103183

Plan
Term
D.O.C.
165
Shukla S
15
05907370
10/01/2011
Page Total (Rs)

Grand Total (Rs)

Inst. Prem(Rs)
Mode
Sum Assured
15,012.00
YLY
3,12,500.00
15,012.00

15,012.00

No Of Inst
Due Fr
Due To
1
01/16
01/16

Total Premium
Late Fee
15,012.00
0.00
15,012.00
0.00
15,012.00
0.00

Service Tax
Edu Cess
Total Amt
0.00
0.00
15,012.00
0.00
0.00
15,012.00
0.00
0.00
15,012.00

Branch
Next Due
370
01/17

RUPEES FIFTEEN THOUSAND TWELVE ONLY

Ku. Shweta Shukla
D/O Sri Ram Krishna Shukla
District & Session Judge
Civil Court Shahdol Dt Shahdol M.P
484001

Payment Acknowledgement generated through Online

Portal on 14-Jan-2016 Time : 20:38:14.

This receipt is electronically generated.

Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi

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