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

: PR0208947800021011 Date ( Time ): 11/10/2010 ( 18:49:46 )

Servicing Branch : 762 LIC of India,Tirupur Br Office P B No-401 1 Mangalam Road Lakshmi Complex. Tirupur (Tn) Tirupur Tamilnadu 641604

RENEWAL PREMIUM RECEIPT
Received with thanks Rs. 6776.00 through Payment Gateway over the Internet from: Smt./Ms./Shri : Sri.C.Mallikarjuna Reddy Towards the following Plan Term D.O.C. 111 Reddy C.M 29 04240762 27/08/1994 762358342 93 C.M.Reddy C 25 04205762 28/09/1999 Page Total (Rs) Policy No Name Agency Code 761312011 Inst. Prem(Rs) Mode Sum Assured 1,198.00 YLY 1,00,000.00 5,570.00 YLY 1,00,000.00 6,768.00 No Of Inst Due Fr Due To 1 08/10 08/10 1 09/10 09/10 Total Premium Late Fee Total Amt 1,198.00 8.00 1,206.00 5,570.00 0.00 5,570.00 6,768.00 8.00 6,776.00 6,768.00 8.00 6,776.00 Branch Next Due 762 08/11 762 09/11

Grand Total (Rs)

6,768.00

RUPEES SIX THOUSAND SEVEN HUNDRED SEVENTY-SIX ONLY Sri.C.Mallikarjuna Reddy 186,V.S.Sivasubramaniam Nagar, Ranganathapuram,Sirupooluvapattip.O Tirupur 641603 A.Mu.Sh.2010/1304/CR 324/M 1 Dated 23/06/2010

This receipt is electronically generated and is digitally signed.

Signature Not Verified
Digitally signed by REKHA VARSHNEY Date: October 11, 2010 6:49:46 PM IST Reason: Premium Receipt Location: LIC OF INDIA

Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi
Page 1of1