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

Bargawan
Transaction No : 27103246
Madhav Nagar,Katni
Date ( Time ): 16/11/2020 ( 18:53:25 ) Katni,483501
Email: bo_eps1@licindia.com
Receipt No : PR2710324600012021
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 1,114.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Pandit Ram Upadhyay

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) (`) (`) (`)
355063119 179 / 16 1,114.00 1 1,114.00 0.00 376
Pandit Ram 28/01/2009 QLY 10/20 0.00 0.00 01/21
No 10/20 0.00 1,114.00 23AAACL0582H2ZT
05066374 50,000.00

Page Total (`) 1,114.00 1,114.00 0.00

0.00 0.00
0.00 1,114.00
Grand Total (`) 1,114.00 1,114.00 0.00
0.00 0.00
0.00 1,114.00

GST borne by LIC of India ` 25.06

ONE THOUSAND ONE HUNDRED FOURTEEN RUPEES AND ZERO PAISE ONLY

Pandit Ram Upadhyay

S/O Sri Chhakodi Lal Upadhyay
Nagar Nigam,Katni
Dt-Katni Mp

483501 Payment Acknowledgement generated through

Online Portal on 16-Nov-20 Time : 18:56:29.
Mobile: 81******41
Email: pa********08@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!