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Collecting Branch : EPS1 Servicing Branch : 11W

E-mail : bo_eps1@licindia.com LIC of India, New Delhi 11W Branch Office


Phone : +91-022-1251 Plot No-17 L.S.C. F-Block
Bhera Enclave Paschim Vihar
Transaction No. : PR1163785500011516 New Delhi.
Paschim Vihar Cbo
Date ( Time ): 28/12/2015 ( 14:46:18 ) 110087

RENEWAL PREMIUM RECEIPT

Received with thanks Rs. 894.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Tarun

Towards the following

Policy No Plan Inst. Prem(Rs) No Of Inst Total Premium Service Tax Branch
Name Term Mode Due Fr Late Fee Edu Cess Next Due
Agency Code D.O.C. Sum Assured Due To Total Amt
331596537 174 894.00 1 894.00 0.00 11W
Kumar T 20 QLY 12/15 0.00 0.00 03/16
0053411W 28/03/2006 1,00,000.00 12/15 894.00
Page Total (Rs) 894.00 894.00 0.00
0.00 0.00
894.00
Grand Total (Rs) 894.00 894.00 0.00
0.00 0.00
894.00

RUPEES EIGHT HUNDRED NINETY-FOUR ONLY

Tarun
C-180
Vandana Vihar
Nangloi New Delhi
110041

This receipt is electronically generated.

Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi


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