Collecting Branch : EPS1 Servicing Branch : LIC of India, Waidhan Branch

Rajkamal Hotel P B No 3.
Transaction No : 14868956
Waidhan Dist Sidhi,
Date ( Time ): 04/11/2018 ( 18:30:17 ) Waidhan,486886
bo_eps1@licindia.com
Receipt No : PR1486895600011819
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 39,251.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Chandrakesh Kumar Shah

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.
(`) (`) (`)
208022733 149 39,251.00 1 39,251.00 0.00 37P
Chandrakesh 75 YLY 11/18 0.00 0.00 11/19
0571737P 28/11/2013 10,00,000 11/18 0.00 39,251.00

Page Total (`) 39,251.00 39,251.00 0.00

0.00 0.00
0.00 39,251.00
Grand Total (`) 39,251.00 39,251.00 0.00
0.00 0.00
0.00 39,251.00

GST borne by LIC of India ` 883.14

THIRTY NINE THOUSAND TWO HUNDRED FIFTY ONE RUPEES AND ZERO PAISE ONLY

Chandrakesh Kumar Shah

Consolidated Stamp Duty Paid
S/O Sri Shyam Das Shah
Village Banauli Po Khutar CSD/64/2018/2366/18 dtd. 26/06/2018
Distt Singrauli M.P.

486886 Payment Acknowledgement generated through

Online Portal on 04-Nov-18 Time : 18:33:37.
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Email: shahrenu1992@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!