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

: PR0793450300011112 Date ( Time ): 01/10/2011 ( 12:22:55 )

Servicing Branch : 646 LIC of India,Gulbarga Br Office No-I L I C Bldg Jail Garden Road P B No 16 Gulbarga. Karnataka Gulbarga 585101

RENEWAL PREMIUM RECEIPT

Received with thanks Rs. 1607.00 through Payment Gateway over the Internet from: Smt./Ms./Shri : Prasad (La) Prabhakar Rao Kulkarni (P) Towards the following Policy No Name Agency Code 663032952 Plan Term D.O.C. 11 Kulkarni 30 02037646 20/09/2002 Page Total (Rs) Inst. Prem(Rs) Mode Sum Assured 1,607.00 YLY 1,00,000.00 1,607.00 No Of Inst Due Fr Due To 1 09/11 09/11 Total Premium Late Fee Total Amt 1,607.00 0.00 1,607.00 1,607.00 0.00 1,607.00 1,607.00 0.00 1,607.00 Branch Next Due 646 09/12

Grand Total (Rs)

1,607.00

RUPEES ONE THOUSAND SIX HUNDRED SEVEN ONLY Prasad (La) Prabhakar Rao Kulkarni (P) H.No. 61, L.I.G. 3rd Phase Badepur Colony, Sedam Road, Gulbarga. 585105 This receipt is electronically generated and is digitally signed.

Signature Not Verified

Digitally signed by REKHA VARSHNEY Date: October 1, 2011 12:22:56 PM IST Reason: Premium Receipt Location: LIC OF INDIA

Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi

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