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

Rajkamal Hotel P B No 3.
Transaction No : 14869325
Waidhan Dist Sidhi,
Date ( Time ): 04/11/2018 ( 18:38:47 ) Waidhan,486886
bo_eps1@licindia.com
Receipt No : PR1486932500011819
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 5,383.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Renu 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.
(`) (`) (`)
208022734 149 5,383.00 1 5,383.00 0.00 37P
Renu Shah 79 YLY 11/18 0.00 0.00 11/19
0571737P 28/11/2013 1,00,000 11/18 0.00 5,383.00

Page Total (`) 5,383.00 5,383.00 0.00

0.00 0.00
0.00 5,383.00
Grand Total (`) 5,383.00 5,383.00 0.00
0.00 0.00
0.00 5,383.00

GST borne by LIC of India ` 121.12

FIVE THOUSAND THREE HUNDRED EIGHTY THREE RUPEES AND ZERO PAISE ONLY

Renu Shah
Consolidated Stamp Duty Paid
S/O Sri Hriday Lal Shaha
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 : 18:40:38.
Mobile: 9532088913
Email: chandushah.2009@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!