914496782_1

Collecting Branch : EPS1 Servicing Branch : LIC of India, Bhusawal Br

LIC OF INDIA, BRANCH OFFICE - 965
Transaction No : 6412640
MEENA COMPLEX, SECOND
Date ( Time ): 26/05/2021 ( 09:36:00 ) DT. JALGAON.,425201
Email: BO_965@LICINDIA.COM
Receipt No : PR0641264000012122
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 17,502.14 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Mahendra Ravindra Patil

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) (`) (`) (`)
914496782 815 / 30 17,117.00 1 17,117.00 192.57 965
Mahendra 27/11/2019 HLY 05/21 0.00 192.57 11/21
No 05/21 0.00 17,502.14 27AAACL0582H1ZM
01712965 10,00,000

Page Total (`) 17,117.00 17,117.00 192.57

0.00 192.57
0.00 17,502.14
Grand Total (`) 17,117.00 17,117.00 192.57
0.00 192.57
0.00 17,502.14

SEVENTEEN THOUSAND FIVE HUNDRED TWO RUPEES AND FOURTEEN PAISE ONLY

Mahendra Ravindra Patil

Consolidated Stamp Duty Paid
Jijau Nagar, Gat No-380/2,
Plot No-47 CSD/113/2020/1936 DTD. 18.09.2020
At/Po- Muktainagar Dist- Jalgaon

425306 Payment Acknowledgement generated through

Online Portal on 26-May-21 Time : 09:38:13.
Mobile: 94******65
Email: ma********95@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!