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

: PR0817874600011112 Date ( Time ): 11/10/2011 ( 13:41:42 )

Servicing Branch : 768 LIC of India,Namakkal Br Office Lic Building 29/C-2 Dr Sankaran Rd P B No-5 Ganeshpuram. Mamakkal Tamilnadu Namakkal 637002

RENEWAL PREMIUM RECEIPT


Received with thanks Rs. 725.00 through Payment Gateway over the Internet from: Smt./Ms./Shri : R.Palanivel Towards the following Plan Term D.O.C. 179 Palanivel R 16 04197768 15/10/2010 Page Total (Rs) Policy No Name Agency Code 704660624 Inst. Prem(Rs) Mode Sum Assured 725.00 QLY 50,000.00 725.00 No Of Inst Due Fr Due To 1 10/11 10/11 Total Premium Late Fee Total Amt 725.00 0.00 725.00 725.00 0.00 725.00 725.00 0.00 725.00 Branch Next Due 768 01/12

Grand Total (Rs)

725.00

RUPEES SEVEN HUNDRED TWENTY-FIVE ONLY R.Palanivel S/O Ramasamy, 1/173 Main Road, Sellappampatty Po, Namakkal Dist 637019 Duplicate receipt generated online through LIC Portal on 11-Oct-2011 Time : 15:10:59

This receipt is electronically generated and is digitally signed.

Signature Not Verified


Digitally signed by REKHA VARSHNEY Date: October 11, 2011 3:10:59 PM IST Reason: Premium Receipt Location: LIC OF INDIA

Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi


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