Collecting Branch : EPS1 Servicing Branch : LIC of India, Mumbai B O 905

Gulestan Bldg Gr Flr

Transaction No : 10786561
M G Road Fort.,Mumbai
Date ( Time ): 25/08/2019 ( 11:15:58 ) Fort,400001
bo_eps1@licindia.com
Receipt No : PR1078656100011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 25,654.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Avalkonde P R
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.
(`) (`) (`)
985974508 149 25,654.00 1 25,654.00 0.00 905
Pravin 79 YLY 08/19 0.00 0.0 08/20
0001394H 17/08/2011 4,00,000 08/19 0.00 25,654.00 0

Page Total (`) 25,654.00 25,654.00 0.00

0.00 0.00
0.00 25,654.00
Grand Total (`) 25,654.00 25,654.00 0.00
0.00 0.00
0.00 25,654.00

GST borne by LIC of India ` 577.22

TWENTY FIVE THOUSAND SIX HUNDRED FIFTY FOUR RUPEES AND ZERO PAISE ONLY

Avalkonde P R
Consolidated Stamp Duty Paid
CSD/328/2019/646/19 DTD.15/02/2019

Payment Acknowledgement generated through

Online Portal on 25-Aug-19 Time : 11:17:00.
Mobile: 7506644811
Email: pravinawalkonde@ymail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!