Collecting Branch : EPS1 Servicing Branch : 58N

E-mail : bo_eps1@licindia.com LIC of India, Cuttack City Branch Office-3

Phone : +91-022-1251 At (Po) Jagatpur
Cuttack.
Transaction No. : PR0854934600011516
Cuttack
Date ( Time ): 22/10/2015 ( 09:52:00 )

RENEWAL PREMIUM RECEIPT

Received with thanks Rs. 4151.60 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Muktikant Mishra

Towards the following

Policy No Plan Inst. Prem(Rs) No Of Inst Total Premium Service Tax Branch
Name Term Mode Due Fr Late Fee Edu Cess Next Due
Agency Code D.O.C. Sum Assured Due To Total Amt
596683140 820 3,951.00 1 3,951.00 138.00 58N
M Mishra 20 HLY 08/15 62.60 0.00 02/16
0108458N 11/02/2015 1,00,000.00 08/15 4,151.60
Page Total (Rs) 3,951.00 3,951.00 138.00
62.60 0.00
4,151.60
Grand Total (Rs) 3,951.00 3,951.00 138.00
62.60 0.00
4,151.60

RUPEES FOUR THOUSAND ONE HUNDRED FIFTY-ONE AND SIXTY PAISE ONLY

Muktikant Mishra
At-Hariharpur Sasan
Po-Sikudi,Via-Rajkanika
Dt-Kendrapara
700000

This receipt is electronically generated.

Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi

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