Collecting Branch : EPS1 Servicing Branch : LIC of India, Gorakhpur Br 281

Buddha Vihar
Transaction No : 9438489
Commercial Scheme,Tara Mandal
Date ( Time ): 04/08/2019 ( 15:12:45 ) Gorakhpur,273001
bo_eps1@licindia.com
Receipt No : PR0943848900011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 3,155.76 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Pushkar Shreshth

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.
(`) (`) (`)
296653735 165 750.00 4 3,000.00 11.88 281
Pushkar 16 QLY 09/18 132.00 11.88 09/19
06388281 28/12/2010 62,500.00 06/19 0.00 3,155.76

Page Total (`) 750.00 3,000.00 11.88

132.00 11.88
0.00 3,155.76
Grand Total (`) 750.00 3,000.00 11.88
132.00 11.88
0.00 3,155.76

GST borne by LIC of India ` 67.52

THREE THOUSAND ONE HUNDRED FIFTY FIVE RUPEES AND SEVENTY SIX PAISE ONLY

Pushkar Shreshth
S/O Sri Hari Bahadur
H.No.109 J Jeetpur Dargahiya
Nanda Nagar,Po-Kunraghat,Gorakhpur

273008 Payment Acknowledgement generated through

Online Portal on 05-Aug-19 Time : 15:41:20.
Mobile: 9935755005
Email: sbhshbahadur@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!