Collecting Branch : EPS1 Servicing Branch : LIC of India, Tanuku Br Office

Jeevan Jyothi P B No-18

Transaction No : 8608938
Sundaramma Nagar Tanuku.,Dist-
Date ( Time ): 23/07/2019 ( 22:48:22 ) Tanuku,534211
bo_eps1@licindia.com
Receipt No : PR0860893800011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 7,423.64 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Gudapati Apparao

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.
(`) (`) (`)
808811497 836 7,130.00 1 7,130.00 90.37 694
Gudapati 25 HLY 05/19 112.90 90.37 11/19
03205694 28/05/2018 3,00,000 05/19 0.00 7,423.64

Page Total (`) 7,130.00 7,130.00 90.37

112.90 90.37
0.00 7,423.64
Grand Total (`) 7,130.00 7,130.00 90.37
112.90 90.37
0.00 7,423.64

SEVEN THOUSAND FOUR HUNDRED TWENTY THREE RUPEES AND SIXTY FOUR PAISE ONLY

Gudapati Apparao
Consolidated Stamp Duty Paid
S/O Venkataratnam, H.No 1-66
Thadithota, Kaldari Po CSD/328/2019/646/19 DTD.15/02/2019
Undrajavaram Mdl W G Dt

534329 Payment Acknowledgement generated through

Online Portal on 23-Jul-19 Time : 22:50:23.
Mobile: 9353004726
Email: appu.gudapati@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!