Collecting Branch : EPS1 Servicing Branch : LIC of India, Sivakasi Branch

P B No-25
Transaction No : 20225034
5-C Velayutham Road.,Sivakasi (Tn)
Date ( Time ): 08/01/2019 ( 15:36:19 ) Sivakasi,626123
bo_eps1@licindia.com
Receipt No : PR2022503400011819
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 3,082.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Smt S Subbulakshmi

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.
(`) (`) (`)
746199251 91 3,082.00 1 3,082.00 0.00 74F
Smt S 18 HLY 01/19 0.00 0.00 07/19
0030074F 12/07/2010 1,00,000 01/19 0.00 3,082.00

Page Total (`) 3,082.00 3,082.00 0.00

0.00 0.00
0.00 3,082.00
Grand Total (`) 3,082.00 3,082.00 0.00
0.00 0.00
0.00 3,082.00

GST borne by LIC of India ` 69.34

THREE THOUSAND EIGHTY TWO RUPEES AND ZERO PAISE ONLY

Smt S Subbulakshmi
W/O Selvam
117,Patti Street,Selvam Mess
Sivakasi

626123 Payment Acknowledgement generated through

Online Portal on 08-Jan-19 Time : 15:40:51.
Mobile: 9442665556
Email: shivadreams@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!