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

131-A B B Ganguly St.

Transaction No : 37678345
Calcutta,
Date ( Time ): 14/02/2021 ( 09:39:18 ) Calcutta,700012
Email: bo_eps1@licindia.com
Receipt No : PR3767834500012021
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 12,097.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Simana Mukherjea

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) (`) (`) (`)
458716212 165 / 15 12,097.00 1 12,097.00 0.00 421
Simana 04/12/2013 QLY 03/21 0.00 0.00 06/21
No 03/21 0.00 12,097.00 19AAACL0582H1ZJ
85397411 9,87,500

Page Total (`) 12,097.00 12,097.00 0.00

0.00 0.00
0.00 12,097.00
Grand Total (`) 12,097.00 12,097.00 0.00
0.00 0.00
0.00 12,097.00

GST borne by LIC of India ` 272.18

TWELVE THOUSAND NINETY SEVEN RUPEES AND ZERO PAISE ONLY

Simana Mukherjea
Consolidated Stamp Duty Paid
11/A, Radha Nath Mullick Lane
Bowbazar CSD/113/2020/1936 DTD. 18.09.2020
Kolkata

700012 Payment Acknowledgement generated through

Online Portal on 14-Feb-21 Time : 09:43:09.
Mobile: 98******98
Email: sa********ea@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!