Collecting Branch : EPS1 Servicing Branch : LIC of India, Dombivli Br 91G

Dombivli Midc Complex

Transaction No : 19497286
Industrial Estate.,Dombivli East
Date ( Time ): 01/01/2019 ( 21:27:59 ) Dombivli(E),421201
bo_eps1@licindia.com
Receipt No : PR1949728600011819
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 834.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Erabatti Rc
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.
(`) (`) (`)
925461097 75 834.00 1 834.00 0.00 91G
Rupali 20 QLY 12/18 0.00 0.00 03/19
0264691G 25/03/2011 50,000.00 12/18 0.00 834.00

Page Total (`) 834.00 834.00 0.00

0.00 0.00
0.00 834.00
Grand Total (`) 834.00 834.00 0.00
0.00 0.00
0.00 834.00

GST borne by LIC of India ` 18.76

EIGHT HUNDRED THIRTY FOUR RUPEES AND ZERO PAISE ONLY

Erabatti Rc
2/30 Swadeshi Mill Rd
Manohar Gujar Chawl
Chunabhatti E Mumbai

400022 Payment Acknowledgement generated through

Online Portal on 01-Jan-19 Time : 21:29:44.
Mobile: 9967505331
Email: ravi.erabatti00@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!