Collecting Branch : EPS1 Servicing Branch : LIC of India, Raipur Branch II

Nav Bharat Press Bldg

Transaction No : 19008631
Rajbandh Maidan.,Raipur Mp
Date ( Time ): 03/02/2018 ( 15:31:24 ) Raipur,0
bo_eps1@licindia.com
Receipt No : PR1900863100011718
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 1,531.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Soni Singh

towards the following :

Policy No Plan Inst. Premium No Of Inst Total Premium CGST Branch

Name Term Mode Due From Late Fee SGST/UTGST Next Due
Agency Code D.O.C. Sum Assured Due To CD Charges Total Amt Reg. No.
(`) (`) (`)
385673373 165 1,531.00 1 1,531.00 0.00 298
Soni Singh 15 QLY 01/18 0.00 0.00 04/18
01804298 17/04/2010 1,25,000 01/18 0.00 1,531.00

Page Total (`) 1,531.00 1,531.00 0.00

0.00 0.00
0.00 1,531.00
Grand Total (`) 1,531.00 1,531.00 0.00
0.00 0.00
0.00 1,531.00

GST borne by LIC of India ` 34.44

ONE THOUSAND FIVE HUNDRED THIRTY ONE RUPEES AND ZERO PAISE ONLY

Soni Singh
D/O Sri Sudhir Prasad Singh
Purani Basti,Near Sitla Mandir ,
Gogaon Raipur Cg

492001 Payment Acknowledgement generated through

Online Portal on 03-Feb-18 Time : 15:33:39.
Mobile: 9981005923
Email: shinusingh54@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!