Collecting Branch : EPS1 Servicing Branch : LIC of India, Vadodara City

4th Flr Baroda Co-Op. Bank Building

Transaction No : 11528628
Near Paradise Complex
Date ( Time ): 31/08/2019 ( 19:37:22 ) Vadodara,390005
bo_eps1@licindia.com
Receipt No : PR1152862800031920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 2,426.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Patel Pritesh Kishankumar

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.
(`) (`) (`)
874593749 165 2,426.00 1 2,426.00 0.00 876
Patel Pritesh 33 HLY 08/19 0.00 0.0 02/20
02863876 09/02/2013 1,00,000 08/19 0.00 2,426.00 0

Page Total (`) 2,426.00 2,426.00 0.00

0.00 0.00
0.00 2,426.00
Grand Total (`) 2,426.00 2,426.00 0.00
0.00 0.00
0.00 2,426.00

GST borne by LIC of India ` 54.58

TWO THOUSAND FOUR HUNDRED TWENTY SIX RUPEES AND ZERO PAISE ONLY

Patel Pritesh Kishankumar

247-Panchshil Nagar-1
Maneja
Vadodara

100000 Payment Acknowledgement generated through

Online Portal on 31-Aug-19 Time : 19:39:28.
Mobile: 7405329442
Email: ppritesh888@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!

 Collecting Branch : EPS1 Servicing Branch : LIC of India, Vadodara City
4th Flr Baroda Co-Op. Bank Building
Transaction No : 11528628
Near Paradise Complex
Date ( Time ): 31/08/2019 ( 19:37:22 ) Vadodara,390005
bo_eps1@licindia.com
Receipt No : PR1152862800031920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 7,610.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Patel Pritesh Kishankumar

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.
(`) (`) (`)
874593751 178 7,610.00 1 7,610.00 0.00 876
Patel Pritesh 76 HLY 08/19 0.00 0.0 02/20
02863876 09/02/2013 3,00,000 08/19 0.00 7,610.00 0

Page Total (`) 7,610.00 7,610.00 0.00

0.00 0.00
0.00 7,610.00
Grand Total (`) 7,610.00 7,610.00 0.00
0.00 0.00
0.00 7,610.00

GST borne by LIC of India ` 171.22

SEVEN THOUSAND SIX HUNDRED TEN RUPEES AND ZERO PAISE ONLY

Patel Pritesh Kishankumar

Consolidated Stamp Duty Paid
247-Panchshil Nagar-1
Maneja CSD/328/2019/646/19 DTD.15/02/2019
Vadodara

100000 Payment Acknowledgement generated through

Online Portal on 31-Aug-19 Time : 19:39:28.
Mobile: 7405329442
Email: ppritesh888@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!

 Collecting Branch : EPS1 Servicing Branch : LIC of India, Vadodara City
4th Flr Baroda Co-Op. Bank Building
Transaction No : 11528628
Near Paradise Complex
Date ( Time ): 31/08/2019 ( 19:37:22 ) Vadodara,390005
bo_eps1@licindia.com
Receipt No : PR1152862800031920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 2,426.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Patel Pritesh Kishankumar

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.
(`) (`) (`)
874593750 165 2,426.00 1 2,426.00 0.00 876
Patel Pritesh 35 HLY 08/19 0.00 0.0 02/20
02863876 09/02/2013 1,00,000 08/19 0.00 2,426.00 0

Page Total (`) 2,426.00 2,426.00 0.00

0.00 0.00
0.00 2,426.00
Grand Total (`) 2,426.00 2,426.00 0.00
0.00 0.00
0.00 2,426.00

GST borne by LIC of India ` 54.58

TWO THOUSAND FOUR HUNDRED TWENTY SIX RUPEES AND ZERO PAISE ONLY

Patel Pritesh Kishankumar

247-Panchshil Nagar-1
Maneja
Vadodara

100000 Payment Acknowledgement generated through

Online Portal on 31-Aug-19 Time : 19:39:28.
Mobile: 7405329442
Email: ppritesh888@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!