Collecting Branch : EPS1 Servicing Branch : LIC of India, Chennai City Br

Norton Essbee Towers

Transaction No : 16331655
128 Bricklin Road,Purasawalkam
Date ( Time ): 25/10/2019 ( 19:53:05 ) Chennai,600007
bo_eps1@licindia.com
Receipt No : PR1633165500011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 1,331.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Velraj Gnanasambandan

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.
(`) (`) (`)
719351512 179 1,331.00 1 1,331.00 0.00 71Z
Velraj.G., 16 QLY 11/19 0.00 0.0 02/20
0175971Z 03/02/2011 1,00,000 11/19 0.00 1,331.00 0

Page Total (`) 1,331.00 1,331.00 0.00

0.00 0.00
0.00 1,331.00
Grand Total (`) 1,331.00 1,331.00 0.00
0.00 0.00
0.00 1,331.00

GST borne by LIC of India ` 29.94

ONE THOUSAND THREE HUNDRED THIRTY ONE RUPEES AND ZERO PAISE ONLY

Velraj Gnanasambandan

Payment Acknowledgement generated through

Online Portal on 25-Oct-19 Time : 19:54:05.
Mobile: 9042447498
Email: g.velraj@hotmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!