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

Post-Hajo.
Transaction No : 4712769
Dist-Kamrup Assam,
Date ( Time ): 03/06/2019 ( 18:35:32 ) Hajo,0
bo_eps1@licindia.com
Receipt No : PR0471276900011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 14,115.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Aswini Choudhury

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.
(`) (`) (`)
485321083 14 14,115.00 1 14,115.00 0.00 4011
Aswini 12 HLY 06/19 0.00 0.00 12/19
001004011 28/12/2010 3,00,000 06/19 0.00 14,115.00

Page Total (`) 14,115.00 14,115.00 0.00

0.00 0.00
0.00 14,115.00
Grand Total (`) 14,115.00 14,115.00 0.00
0.00 0.00
0.00 14,115.00

GST borne by LIC of India ` 317.58

FOURTEEN THOUSAND ONE HUNDRED FIFTEEN RUPEES AND ZERO PAISE ONLY

Aswini Choudhury
Consolidated Stamp Duty Paid
Forest School,Kailashpur
Po.G.U CSD/328/2019/646/19 DTD.15/02/2019
Guwahati-14

781014 Payment Acknowledgement generated through

Online Portal on 03-Jun-19 Time : 18:38:26.
Mobile: 9435109207
Email: achoudhury737@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!