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

E-3, Sector 1,
Transaction No : 21392698
Noida,,
Date ( Time ): 25/12/2019 ( 17:44:19 ) Noida,201301
bo_eps1@licindia.com
Receipt No : PR2139269800011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 3,126.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Amarajeet
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.
(`) (`) (`)
255899552 165 3,126.00 1 3,126.00 0.00 25J
Amarajeet 15 HLY 11/19 0.00 0.0 05/20
0393025J 25/05/2010 11/19 0.00 3,126.00 09AAACL0582HFZ6
1,25,000

Page Total (`) 3,126.00 3,126.00 0.00

0.00 0.00
0.00 3,126.00
Grand Total (`) 3,126.00 3,126.00 0.00
0.00 0.00
0.00 3,126.00

GST borne by LIC of India ` 70.34

THREE THOUSAND ONE HUNDRED TWENTY SIX RUPEES AND ZERO PAISE ONLY

Amarajeet
G-127, Sec- 20
Noida
G.B.Nagar

201301 Payment Acknowledgement generated through

Online Portal on 25-Dec-19 Time : 17:47:06.
Mobile: 9953814386
Email: vijender_05@yahoo.co.in

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!