Collecting Branch : EPS1 Servicing Branch : LIC of India, Bareilly District

156 Civil Lines.

Transaction No : 28800012
Bareilly,
Date ( Time ): 07/03/2020 ( 20:31:43 ) Bareilly,243001
bo_eps1@licindia.com
Receipt No : PR2880001200011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 9,603.32 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Manjusha
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.
(`) (`) (`)
209978053 815 9,392.00 1 9,392.00 105.66 396
Manjusha 21 HLY 03/20 0.00 105.66 09/20
01964396 05/03/2019 03/20 0.00 9,603.32 09AAACL0582HFZ6
3,00,000

Page Total (`) 9,392.00 9,392.00 105.66

0.00 105.66
0.00 9,603.32
Grand Total (`) 9,392.00 9,392.00 105.66
0.00 105.66
0.00 9,603.32

NINE THOUSAND SIX HUNDRED THREE RUPEES AND THIRTY TWO PAISE ONLY

Manjusha
Consolidated Stamp Duty Paid
W/O Shri Ram Prabodh Singh
Q No-500-1,New Model Railway Colony CSD/328/2019/646/19 DTD.15/02/2019
Izzat Nagar Bareilly

243122 Payment Acknowledgement generated through

Online Portal on 07-Mar-20 Time : 20:38:11.
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Email: ankit07kumar7@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!