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Collecting Branch : EPS1

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

Servicing Branch : 6041


LIC of India, Hyderabad CBO-21
Near Nallakunta Bridge
Barkatpura.
Hyderabad
Kachiguda
500027

Transaction No. : PR1438790300011516


Date ( Time ): 16/02/2016 ( 16:09:39 )

RENEWAL PREMIUM RECEIPT


Received with thanks Rs. 1415.00 through Payment Gateway over the Internet from:
Smt./Ms./Shri : Biswa Ranjanjena
Towards the following
Policy No
Name
Agency Code
645807100

Plan
Term
D.O.C.
149
Biswaranjan Jena
75
015946041
11/08/2009
Page Total (Rs)

Grand Total (Rs)

Inst. Prem(Rs)
Mode
Sum Assured
1,415.00
QLY
1,00,000.00
1,415.00

No Of Inst
Due Fr
Due To
1
02/16
02/16

1,415.00

Total Premium
Late Fee
1,415.00
0.00
1,415.00
0.00
1,415.00
0.00

Service Tax
Edu Cess
Total Amt
0.00
0.00
1,415.00
0.00
0.00
1,415.00
0.00
0.00
1,415.00

Branch
Next Due
6041
05/16

RUPEES ONE THOUSAND FOUR HUNDRED FIFTEEN ONLY


Biswa Ranjanjena
S/O Sridhar Jena
At/Post.Manatira Via Danagadi
Dist Jajpur State Orissa
755026
This receipt is electronically generated.

Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi


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