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

Jeevan Jyothi P B No-18

Transaction No : 17721473
Sundaramma Nagar Tanuku.,Dist-
Date ( Time ): 12/12/2018 ( 13:35:26 ) Tanuku,534211
bo_eps1@licindia.com
Receipt No : PR1772147300011819
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 7,450.86 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 7,130.00 160.43 694
Gudapati 25 HLY 11/18 0.00 160.43 05/19
03205694 28/05/2018 3,00,000 11/18 0.00 7,450.86

Page Total (`) 7,130.00 7,130.00 160.43

0.00 160.43
0.00 7,450.86
Grand Total (`) 7,130.00 7,130.00 160.43
0.00 160.43
0.00 7,450.86

SEVEN THOUSAND FOUR HUNDRED FIFTY RUPEES AND EIGHTY SIX PAISE ONLY

Gudapati Apparao
Consolidated Stamp Duty Paid
S/O Venkataratnam, H.No 1-66
Thadithota, Kaldari Po CSD/64/2018/2366/18 dtd. 26/06/2018
Undrajavaram Mdl W G Dt

534329 Payment Acknowledgement generated through

Online Portal on 12-Dec-18 Time : 13:36:56.
Mobile: 9353004726
Email: appu.gudapati@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!