Collecting Branch : EPS1 Servicing Branch : 492

E-mail : bo_eps1@licindia.com LIC of India, Tinsukia Branch Office

Phone : +91-022-1251 D M Mansion G N B Road.
Tinsukia
Transaction No. : PR0584265800011718
Tinsukia
Date ( Time ): 27/07/2017 ( 21:06:23 ) 786121

RENEWAL PREMIUM RECEIPT

Received with thanks Rs. 31009.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Amarjyoti Dihingia

Towards the following

Policy No Plan Inst. Prem(Rs) No Of Inst Total Premium Tax * Branch

Name Term Mode Due Fr Late Fee Total Amt Next Due
Agency Code D.O.C. Sum Assured Due To CD Charges Reg. No.
136330628 836 29,674.00 1 29,674.00 1,335.00 492
A Dihingia A 21 HLY 07/17 0.00 31,009.00 01/18
02694492 28/01/2017 11,00,000.00 07/17 0.00 18AAACL0582H1ZL
Page Total (Rs) 29,674.00 29,674.00 1,335.00
0.00 31,009.00
0.00
Grand Total (Rs) 29,674.00 29,674.00 1,335.00
0.00 31,009.00
0.00

RUPEES THIRTY-ONE THOUSAND NINE ONLY

Amarjyoti Dihingia AMuSh2016/2967/CR747/M1 w.e.f. 30/11/2016

Niz Chabua, Mes Tiniali
P.O. Chabua,
Dist. Dibrugarh, Assam
786184

This receipt is electronically generated.

*Tax here indicates Goods and Services Tax(GST) from 1 July 2017 or Service Tax prior to 1 July 2017.

Har Pal Aap Ke Saath

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