Collecting Branch : EPS1 Servicing Branch : 871

E-mail : bo_eps1@licindia.com LIC of India, Vadodara City Br I

Phone : +91-022-1251 11nd Floor Navrang Complex
Hotel Utsav Compound.
Transaction No. : PR1888443100051819 Prof Manekrao Rd Vadodara
Vadodara Cbo-1
Date ( Time ): 27/12/2018 ( 09:47:23 ) 390001

RENEWAL PREMIUM RECEIPT

Received with thanks Rs. 21439.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Vishal Pandita

Towards the following

Policy No Plan Inst. Prem(Rs) No Of Inst Total Premium CGST Branch

Name Term Mode Due Fr Late Fee SGST/UTGST Next Due
Agency D.O.C. Sum Assured Due To CD Charges Total Amt Reg. No.
Code
873062987 150 2,770.00 1 2,770.00 0.00 871
Pandita Vp 30 YLY 11/18 0.00 0.00 11/19
04343871 28/11/2003 3,00,000.00 11/18 0.00 2,770.00 24AAACL0582H2ZR
873060219 149 5,214.00 1 5,214.00 0.00 871
Pandita V 74 YLY 11/18 0.00 0.00 11/19
04343871 28/11/2003 1,00,000.00 11/18 0.00 5,214.00 24AAACL0582H2ZR
873060218 149 5,214.00 1 5,214.00 0.00 871
Pandita V 74 YLY 11/18 0.00 0.00 11/19
04343871 28/11/2003 1,00,000.00 11/18 0.00 5,214.00 24AAACL0582H2ZR
873062988 133 2,308.00 1 2,308.00 0.00 871
Pandita Vp 25 YLY 11/18 0.00 0.00 11/19
04343871 28/11/2003 50,000.00 11/18 0.00 2,308.00 24AAACL0582H2ZR
873067631 108 5,933.00 1 5,933.00 0.00 871
Pandita V 25 YLY 11/18 0.00 0.00 11/19
04343871 28/11/2003 75,000.00 11/18 0.00 5,933.00 24AAACL0582H2ZR
Page Total (Rs) 21,439.00 21,439.00 0.00
0.00 0.00
0.00 21,439.00
Grand Total (Rs) 21,439.00 21,439.00 0.00
0.00 0.00
0.00 21,439.00

RUPEES TWENTY-ONE THOUSAND FOUR HUNDRED THIRTY-NINE ONLY

Vishal Pandita CSD/64/2018/2366/18 dtd. 26/06/2018

C/O Sanjay Kaul
Flat No 9, Building 14, Atur Park
Koregaon Park, Pune- Maharashtra
411001

This receipt is electronically generated.

Har Pal Aap Ke Saath

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**GST borne by LIC of India is Rs 482.40

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