Collecting Branch : EPS1 Servicing Branch : 529

E-mail : bo_eps1@licindia.com LIC of India, Coonoor

Phone : +91-022-1251 Branch Office
N.K.N Complex, BedFord,
Transaction No. : PR1402942200022654 Coonoor- 643101
Date ( Time ): 28/06/2019 ( 07:20:20 )

RENEWAL PREMIUM ACKNOWLEDGEMENT

Received with thanks Rs. 25345.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Praveen Antony

Towards the following

Policy No Plan Inst. Prem(Rs) No Of Inst Total Premium Service Tax Branch
Name Term Mode Sum Due Late Fee Edu Cess Next Due
Agency Code D.O.C. Assured Fr Total Amt
519292342 179 25,345.00 1 25,345.00 0.00 529
Kumar R 16 YLY 07/16 0.00 0.00 07/20
04375467K 28/06/2014 22,50,000.00 07/16 25,345.00 20
Page Total (Rs) 25,345.00 25,345.00 0.00
0.00 0.00
25,345.00
Grand Total (Rs) 25,345.00 25,345.00 0.00
0.00 0.00
25,345.00

RUPEES TWENTY FIVE THOUSAND THREE HUNDRED FORTY FIVE

ONL
This receipt is electronically generated

Payment Acknowledgement generated through Online

Portal on 28/06/2019 ( 07:20:20
This receipt is electronically generated.