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

Jeevan Jyothi Trikkandiyur

Transaction No : 27583179
Tirur Kerala,
Date ( Time ): 25/02/2020 ( 20:18:30 ) Thirur,676104
bo_eps1@licindia.com
Receipt No : PR2758317900011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 1,05,190.32 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Dr.Chathapuram Mohan Rajeswari

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.
(`) (`) (`)
318154181 848 1,02,750.00 1 1,02,750.00 1,155.94 779
Dr.Chathapuram 18 QLY 02/20 0.00 1,284.38 05/20
01957779 28/02/2019 02/20 0.00 1,05,190.32 32AAACL0582H1ZV
50,00,000

Page Total (`) 1,02,750.00 1,02,750.00 1,155.94

0.00 1,284.38
0.00 1,05,190.32
Grand Total (`) 1,02,750.00 1,02,750.00 1,155.94
0.00 1,284.38
0.00 1,05,190.32

SGST includes state cess of 128.44

ONE LAKH FIVE THOUSAND ONE HUNDRED NINETY RUPEES AND THIRTY TWO PAISE ONLY

Dr.Chathapuram Mohan Rajeswari

Consolidated Stamp Duty Paid
Saritha Sadan,
Kannamangalam Po,Vengara Via CSD/328/2019/646/19 DTD.15/02/2019
Malappuram Dt

676304 Payment Acknowledgement generated through

Online Portal on 25-Feb-20 Time : 20:20:48.
Mobile: 7907232788
Email: rajmoh84@yahoo.co.in

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!