Collecting Center : A001 Branch Code : 58A

LIC of India, Nayagarh Br Office

Transaction No. : 29412113 LIC OF INDIA,NAYAGARH BR OFFICE
MAIN ROAD
Date ( Time ): 22/06/2021 ( 21:04:27 ) DIST-NAYAGARH (ORISSA), 752069
email: BO_58A@LICINDIA.COM
Call Center No: 022-68276827

RENEWAL PREMIUM RECEIPT

Received with thanks Rs. 6,036.00 from policyholder Shri/Smt.Ashutosh Mohanty

towards the following policy/ies

Policy No Plan Inst. Prem(Rs) No Of Inst Total Premium CGST Branch | Agency
Name Term Mode Due Fr Late Fee SGST*/UTGST Code
Revival D.O.C. Sum Assured Due To CD Chgs + Total Amt Next Due
(Yes/No) Xcharge Reg. No.
828172263 834 5,797.00 1 5,797.00 73.48 58A |0115958A
A Mohanty 21 YLY 04/21 91.80 73.48 04/22
Yes 28/04/2018 1,00,000.00 04/21 0.00 + 0.00 6,035.76 21AAACL0582H1ZY
Page Total (Rs) 5,797.00 5,797.00 73.48
91.80 73.48
0.00 6,035.76
Grand Total (Rs) 5,797.00 5,797.00 73.48
91.80 73.48
0.00 6,035.76

RUPEES SIX THOUSAND THIRTY-SIX ONLY

Paid by Cash/Card/Sr :6,035.76
Paid by Cheque :0.00
Cheque No/ChequeDate : 0/

Ashutosh Mohanty Consolidated Stamp Duty Paid

S/O-Sridhar Mohanty CSD/113/2020/1936 DTD. 18.09.2020
At-Kadua,Po-Rasanga
Via-Gania , Dt-Nayagarh Odisha
752085. For Life Insurance Corporation of India,
Mobile: Suresh Chandra Parida(0115958A)

*SGST also includes cess amount of Rs. 0.00.

GST and Cess borne by LIC of India is Rs 0.00

Har Pal Aapke Sath!!