Collecting Branch : EPS1 Branch Code : EPS1

PCMC, Network Operating Center

Transaction No. : PR0142449200010910 1st Floor, Jeevan Seva Annexe,
S.V.Road, Santacruz(W)
Date ( Time ): 06/10/2009 ( 11:02:21 ) Mumbai - 400 054
Ph. : +91-022-1251
e-mail : bo_eps1@licindia.com

RENEWAL PREMIUM RECEIPT

Received with thanks Rs. 3,949.10 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Naveen Kumar Rai

Towards the following

Policy No Plan Inst. Prem(Rs) No Of Inst Total Premium Branch

Name Term Mode Due Fr Late Fee Next Due
Agency Code D.O.C. Sum Assured Due To Total Amt
112364302 108 1,955.00 2 3,910.00 11J
83395111 25 QLY 06/09 39.10 12/09
28/03/1998 1,00,000.00 09/09 3,949.10
Page Total (Rs) 1,955.00 3,910.00
39.10
3,949.10
Grand Total (Rs) 1,955.00 3,910.00
39.10
3,949.10

RUPEES THREE THOUSAND NINE HUNDRED FORTY-NINE AND TEN PAISE ONLY

Naveen Kumar Rai

F-169,Nauroji Nagar,
Opp-Bhikaji Kama Flyover,
New Delhi.
110029

This receipt is electronically generated and is digitally signed.

Signature Not Verified

Digitally signed by REKHA VARSHNEY
Date: October 6, 2009 11:02:21 AM IST
Reason: Premium Receipt
Location: LIC OF INDIA

Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi

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