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

: PR0016162500011213 Date ( Time ): 06/04/2012 ( 12:05:19 )

Servicing Branch : 934 LIC of India,Kalyan Br I 934 Shreeji Krupa Karnik Road Off Murbad Road. Kalyan Dist Thane Kalyan 421301

RENEWAL PREMIUM RECEIPT

Received with thanks Rs. 9002.00 through Payment Gateway over the Internet from: Smt./Ms./Shri : Mr.Nayak Sudarshan R. Towards the following Plan Term D.O.C. 107 S R Nayak Mr 20 03615934 10/04/2009 Page Total (Rs) Policy No Name Agency Code 924895832 Inst. Prem(Rs) Mode Sum Assured 9,002.00 YLY 1,00,000.00 9,002.00 No Of Inst Due Fr Due To 1 04/12 04/12 Total Premium Late Fee Total Amt 9,002.00 0.00 9,002.00 9,002.00 0.00 9,002.00 9,002.00 0.00 9,002.00 Branch Next Due 934 04/13

Grand Total (Rs)

9,002.00

RUPEES NINE THOUSAND TWO ONLY Mr.Nayak Sudarshan R. 7/1202 Indraprasth Nr Adharwadi Chowk Off Mohinder Singh Kabul School Kalyan (W) Dist Thane 421301 Duplicate receipt generated online through LIC Portal on 06-Apr-2012 Time : 12:39:22

This receipt is electronically generated and is digitally signed.

Signature Not Verified

Digitally signed by REKHA VARSHNEY Date: April 6, 2012 12:39:22 PM IST Reason: Premium Receipt Location: LIC OF INDIA

Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi

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