998257499_1

Collecting Branch : EPS1 Servicing Branch : LIC of India, Nagaon Br Office

LIC OF INDIA,NAGAON BR OFFICE
Transaction No : 17714459
ITACHAL,A T ROAD.
Date ( Time ): 06/09/2021 ( 20:48:50 ) DIST-NAGAON (ASSAM),782001
Email: BO_488@LICINDIA.COM
Receipt No : PR1771445900012122
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 1,576.48 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Sar Sing Dera

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) (`) (`) (`)
998257499 822 /8 1,336.00 1 1,336.00 120.24 488
Sar Sing Dera 21/09/2016 HLY 09/21 0.00 120.24 03/22
No 09/21 0.00 1,576.48 18AAACL0582H1ZL
07342488 10,00,000

Page Total (`) 1,336.00 1,336.00 120.24

0.00 120.24
0.00 1,576.48
Grand Total (`) 1,336.00 1,336.00 120.24
0.00 120.24
0.00 1,576.48

ONE THOUSAND FIVE HUNDRED SEVENTY SIX RUPEES AND FORTY EIGHT PAISE ONLY

Sar Sing Dera

S/O- Lt Mon Sing Dera
Vill- Harlongsora, P.O.- Jengkha
Dt- Karbi Anglong, Assam

782448 Payment Acknowledgement generated through

Online Portal on 06-Sep-21 Time : 20:50:42.
Mobile: 88******15
Email: sd********nk@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!