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

Chatrapur.
Transaction No : 12842883
Dist Ganjam,
Date ( Time ): 14/09/2019 ( 11:29:19 ) Chhatrapur,761020
bo_eps1@licindia.com
Receipt No : PR1284288300011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 6,115.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Harihar Bhatta

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.
(`) (`) (`)
573676272 149 6,115.00 1 6,115.00 0.00 58L
Harihara Bhatta 71 HLY 09/19 0.00 0.0 03/20
0198058L 28/03/2012 3,00,000 09/19 0.00 6,115.00 0

Page Total (`) 6,115.00 6,115.00 0.00

0.00 0.00
0.00 6,115.00
Grand Total (`) 6,115.00 6,115.00 0.00
0.00 0.00
0.00 6,115.00

GST borne by LIC of India ` 137.58

SIX THOUSAND ONE HUNDRED FIFTEEN RUPEES AND ZERO PAISE ONLY

Harihar Bhatta
Consolidated Stamp Duty Paid
At-Mohanty Street
Po-Borigumma CSD/328/2019/646/19 DTD.15/02/2019
Dt-Koraput(Odisha)

764056 Payment Acknowledgement generated through

Online Portal on 14-Sep-19 Time : 11:30:41.
Mobile: 9438719827
Email: urwithbhatt@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!