Collecting Branch : EPS1 Servicing Branch : 13R

E-mail : bo_eps1@licindia.com LIC of India, Fazilka Branch Office

Phone : +91-022-1251 P B No 10
Opp. T.V. Tower
Transaction No. : PR0827022700011718 Abohar Road
Fazilka
Date ( Time ): 04/09/2017 ( 22:18:26 ) Punjab 152123

RENEWAL PREMIUM ACKNOWLEDGEMENT

Received with thanks Rs. 4216.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Akashdeep Singh

Towards the following

Policy No Plan Inst. Prem(Rs) No Of Inst Total Premium Tax * Branch

Name Term Mode Due Fr Late Fee Total Amt Next Due
Agency Code D.O.C. Sum Assured Due To CD Charges Reg. No.
473946153 815 4,123.00 1 4,123.00 93.00 13R
Akashdeep Singh A S 26 HLY 08/17 0.00 4,216.00 02/18
3274013R 05/08/2015 2,00,000.00 08/17 0.00 03AAACL0582H1ZW
Page Total (Rs) 4,123.00 4,123.00 93.00
0.00 4,216.00
0.00
Grand Total (Rs) 4,123.00 4,123.00 93.00
0.00 4,216.00
0.00

RUPEES FOUR THOUSAND TWO HUNDRED SIXTEEN ONLY

Akashdeep Singh Payment Acknowledgement generated through Online

S/O Sh Surjeet Singh Portal on 05-Sep-2017 Time : 11:07:44.
Hn-1163/2;Rani Mahal
Teh .Jalalabad W -Fazilka
152024

This receipt is electronically generated.

*Tax here indicates Goods and Services Tax(GST) from 1 July 2017 or Service Tax prior to 1 July 2017.

Har Pal Aap Ke Saath

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