Collecting Center : A001 Branch Code : 58A

LIC of India, Nayagarh Br Office

Transaction No. : 29411614 LIC OF INDIA,NAYAGARH BR OFFICE
MAIN ROAD
Date ( Time ): 22/06/2021 ( 21:00:27 ) DIST-NAYAGARH (ORISSA), 752069
email: BO_58A@LICINDIA.COM
Call Center No: 022-68276827

RENEWAL PREMIUM RECEIPT

Received with thanks Rs. 3,202.00 from policyholder Shri/Smt.Sridhar Mahanty

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.
574661647 103 3,115.00 1 3,115.00 6.66 58A |80001904
S Mahanty 20 YLY 03/21 74.00 6.66 03/22
Yes 23/03/2013 50,000.00 03/21 0.00 + 0.00 3,202.32 21AAACL0582H1ZY
Page Total (Rs) 3,115.00 3,115.00 6.66
74.00 6.66
0.00 3,202.32
Grand Total (Rs) 3,115.00 3,115.00 6.66
74.00 6.66
0.00 3,202.32

RUPEES THREE THOUSAND TWO HUNDRED TWO ONLY

Paid by Cash/Card/Sr :3,202.32
Paid by Cheque :0.00
Cheque No/ChequeDate : 0/

Sridhar Mahanty Consolidated Stamp Duty Paid

S/O-Adeita Mahanty
At-Kanda,Po-Rasanga
Via-Gania,Dt-Nayagarh Odisha For Life Insurance Corporation of India,
752085. Suresh Chandra Parida(0115958A)
Mobile:

*SGST also includes cess amount of Rs. 0.00.

GST and Cess borne by LIC of India is Rs 70.08

Har Pal Aapke Sath!!