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

P B No-15 Jeevan Jyothi

Transaction No : 16634032
12/2/78 Main Road,Kovvur.Dist-West
Date ( Time ): 29/10/2019 ( 21:15:48 ) Kovvur,534350
bo_eps1@licindia.com
Receipt No : PR1663403200011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 3,637.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Uppala Venkata Padmavathi

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.
(`) (`) (`)
805153250 179 3,637.00 1 3,637.00 0.00 698
Uppala Venkata 20 HLY 11/19 0.00 0.0 05/20
01875698 02/05/2013 2,00,000 11/19 0.00 3,637.00 0

Page Total (`) 3,637.00 3,637.00 0.00

0.00 0.00
0.00 3,637.00
Grand Total (`) 3,637.00 3,637.00 0.00
0.00 0.00
0.00 3,637.00

GST borne by LIC of India ` 81.84

THREE THOUSAND SIX HUNDRED THIRTY SEVEN RUPEES AND ZERO PAISE ONLY

Uppala Venkata Padmavathi

W/O U Naga Babu
C/O Sri Vasavi Kirana General Stores,
D.No.34-23/1,Sirisamajam Road.Tanu

534211 Payment Acknowledgement generated through

Online Portal on 29-Oct-19 Time : 21:17:18.
Mobile: 9160377377
Email: babu.uppala77@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!