Collecting Branch : EPS1 Servicing Branch : LIC of India, Hydeabad C B 6 ,

Taramandal Complex 2nd Floor

Transaction No : 7476400
Sectl Rd,
Date ( Time ): 24/08/2017 ( 20:30:52 ) Hyderabad,500029
bo_eps1@licindia.com
Receipt No : PR0747640000061718
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received With Thanks ` 27,402.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Pathakota Sainiranjankumar

Towards The Following :

Policy No Plan Inst. Premium No Of Inst Total Premium Tax* Branch

Name Term Mode Due From Late Fee Total Amt Next Due
Agency Code D.O.C. Sum Assured Due To CD Charges Reg. No.
(`) (`) (`)
648725146 815 1,644.00 1 1,644.00 37.00 800
P Sai Niranjan 19 Qly 09/17 0.00 1,681.00 12/17
01854800 05/06/2014 1,00,000 09/17 0.00

648725147 815 1,555.00 1 1,555.00 35.00 800

P Sai Niranjan 20 Qly 09/17 0.00 1,590.00 12/17
01854800 05/06/2014 1,00,000 09/17 0.00

648725144 815 1,855.00 1 1,855.00 42.00 800

P Sai Niranjan 17 Qly 09/17 0.00 1,897.00 12/17
01854800 05/06/2014 1,00,000 09/17 0.00

648725145 815 1,744.00 1 1,744.00 39.00 800

P Sai Niranjan 18 Qly 09/17 0.00 1,783.00 12/17
01854800 05/06/2014 1,00,000 09/17 0.00

648628591 149 18,426.00 1 18,426.00 0.00 800

P Sai Niranjan 68 Hly 08/17 0.00 18,426.00 02/18
01854800 19/08/2013 5,00,000 08/17 0.00

648725143 815 1,980.00 1 1,980.00 45.00 800

P Sai Niranjan 16 Qly 09/17 0.00 2,025.00 12/17
01854800 05/06/2014 1,00,000 09/17 0.00

Page Total (`) 27,204.00 27,204.00 198.00

0.00 27,402.00
0.00
Grand Total (`) 27,204.00 27,204.00 198.00
0.00 27,402.00
0.00

This receipt is electronically generated.

Har Pal Aapke Saath!

Page 0 of 2
TWENTY SEVEN THOUSAND FOUR HUNDRED TWO RUPEES AND ZERO PAISE ONLY

Pathakota Sainiranjankumar Consolidated Stamp Duty paid

9-1-34/30/39, 1st Floor,Nr. St.Anthony AMuSh2016/2967/CR747/M1 w.e.f. 30/11/2016
School, Bapu Nagar
Langer House, Hyderabad

500008 Payment Acknowledgement generated through

Online Portal on 24-Aug-17 Time : 20:32:34.
Mobile: 8125134598
Email: niranjan.merits@gmail.com

*Tax here indicates Goods and Service Tax (GST) from 01/07/2017 or Service Tax prior to 01/07/2017.

This receipt is electronically generated.

Har Pal Aapke Saath!

Page 1 of 2