815910213_1

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

LIC OF INDIA,JUNAGADH BRANCH II
Transaction No : 13702943
TALAO GATE.,JUNAGADH
Date ( Time ): 31/07/2021 ( 14:26:09 ) ,362001
Email: BO_8077@LICINDIA.COM
Receipt No : PR1370294300012122
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 4,253.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Hetalben Babubhai Chavda

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) (`) (`) (`)
815910213 149 / 73 4,253.00 1 4,253.00 0.00 8077
Hetalben 28/07/2013 YLY 07/21 0.00 0.00 07/22
No 07/21 0.00 4,253.00 24AAACL0582H2ZR
8000141U 1,00,000

Page Total (`) 4,253.00 4,253.00 0.00

0.00 0.00
0.00 4,253.00
Grand Total (`) 4,253.00 4,253.00 0.00
0.00 0.00
0.00 4,253.00

GST borne by LIC of India ` 95.70

FOUR THOUSAND TWO HUNDRED FIFTY THREE RUPEES AND ZERO PAISE ONLY

Hetalben Babubhai Chavda

Nirant ,11-Shivani Park,
B/H Miranagar,Nr.New Collector Office,
Junagadh

362001 Payment Acknowledgement generated through

Online Portal on 31-Jul-21 Time : 14:28:35.
Mobile: 94******52
Email: he********77@gmail.com
For Payment related queries-Email: bo_eps1@licindia.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!