Collecting Branch : EPS1 Servicing Branch : LIC of India, Palakol B O,P B

Jeevan Jyothi D No-11-1-13&14

Transaction No : 28304548
1st Lane Bradipeta.,Palakol (Ap)
Date ( Time ): 28/11/2020 ( 15:53:49 ) Palakol,534260
Email: bo_eps1@licindia.com
Receipt No : PR2830454800012021
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 80,413.50 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Akula Satya Sai Siva Rama Krishna

towards the following :

Policy No Plan / Term Inst. Premium No Of Inst Total Premium CGST Branch
Name D.O.C. Mode Due From Late Fee SGST/UTGST Next Due
Revival Sum Assured Due To CD Charges Total Amt Reg. No.
Agency Code
(Yes/No) (`) (`) (`)
806468731 845 / 77 78,644.00 1 78,644.00 884.75 67B
Akula Satya Sai 27/11/2019 YLY 11/20 0.00 884.75 11/21
No 11/20 0.00 80,413.50 37AAACL0582H2ZK
0204467B 10,00,000

Page Total (`) 78,644.00 78,644.00 884.75

0.00 884.75
0.00 80,413.50
Grand Total (`) 78,644.00 78,644.00 884.75
0.00 884.75
0.00 80,413.50

EIGHTY THOUSAND FOUR HUNDRED THIRTEEN RUPEES AND FIFTY PAISE ONLY

Akula Satya Sai Siva Rama Krishna

Consolidated Stamp Duty Paid
S/O A N V Surya Prakash
H.No 41-2-11, Budhavarapu Street, CSD/113/2020/1936 DTD. 18.09.2020
Palakollu, W.G.Dt, A.P.

534260 Payment Acknowledgement generated through

Online Portal on 28-Nov-20 Time : 15:56:11.
Mobile: 94******14
Email: sa********97@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!