Collecting Branch : EPS1 Servicing Branch : LIC of India, Namakkal Br

Lic Building 29/C-2 Dr Sankaran Rd

Transaction No : 13053764
P B No-5 Ganeshpuram.,Mamakkal
Date ( Time ): 16/09/2019 ( 19:10:52 ) Namakkal,637002
bo_eps1@licindia.com
Receipt No : PR1305376400011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 4,789.51 through Payment Gateway over the Internet from:

Smt./Ms./Shri : A.Jagadeeswaran M.A B.Ed

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.
(`) (`) (`)
702165302 179 1,533.00 3 4,599.00 14.53 768
Smt V 20 MLY 07/19 36.45 14.53 10/19
04079768 20/04/2007 5,00,000 09/19 125.00 4,789.51 0

Page Total (`) 1,533.00 4,599.00 14.53

36.45 14.53
125.00 4,789.51
Grand Total (`) 1,533.00 4,599.00 14.53
36.45 14.53
125.00 4,789.51

GST borne by LIC of India ` 103.48

FOUR THOUSAND SEVEN HUNDRED EIGHTY NINE RUPEES AND FIFTY ONE PAISE ONLY

A.Jagadeeswaran M.A B.Ed

S/O G.Amirthalingam
1/210,Periya Ayyampalayam,
Nallipalayam.Po,Namakkal.

637003 Payment Acknowledgement generated through

Online Portal on 16-Sep-19 Time : 19:14:13.
Mobile: 9578436725
Email: jaganvishnu22@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!