Collecting Branch : EPS1 Servicing Branch : LIC of India, Bhawani Patna

Main Rd Bhawani Patna.

Transaction No : 22728182
Dt Kalahandi Orissa,
Date ( Time ): 06/01/2020 ( 00:46:33 ) Bhawanipatna,766011
bo_eps1@licindia.com
Receipt No : PR2272818200011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 7,452.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Jasmita Meher

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.
(`) (`) (`)
573750360 179 7,452.00 1 7,452.00 0.00 509
Jasmita Meher 20 HLY 01/20 0.00 0.0 07/20
01671509 11/07/2012 01/20 0.00 7,452.00 21AAACL0582H1ZY
4,00,000

Page Total (`) 7,452.00 7,452.00 0.00

0.00 0.00
0.00 7,452.00
Grand Total (`) 7,452.00 7,452.00 0.00
0.00 0.00
0.00 7,452.00

GST borne by LIC of India ` 167.68

SEVEN THOUSAND FOUR HUNDRED FIFTY TWO RUPEES AND ZERO PAISE ONLY

Jasmita Meher
Consolidated Stamp Duty Paid
D/O Bimbadhar Meher
At/Po Chichaiguda,Via Junagarh, CSD/328/2019/646/19 DTD.15/02/2019
Dist Kalahandi,State Odisha

766014 Payment Acknowledgement generated through

Online Portal on 06-Jan-20 Time : 00:48:43.
Mobile: 9945345454
Email: jasmita.meher@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!