634770719_1

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

LIC OF INDIA,CHIKODI BR OFFICE
Transaction No : 16127178
EXTENSION,CHIKODI DIST
Date ( Time ): 24/08/2021 ( 13:20:13 ) KARNATAKA,591201
Email: BO_636@LICINDIA.COM
Receipt No : PR1612717800012122
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 1,630.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Halappa Balaram Gondhalli

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) (`) (`) (`)
634770719 91 / 19 1,630.00 1 1,630.00 0.00 636
Halappa 28/08/2006 YLY 08/21 0.00 0.00 08/22
No 08/21 0.00 1,630.00 29AAACL0582H2ZH
02471636 30,000.00

Page Total (`) 1,630.00 1,630.00 0.00

0.00 0.00
0.00 1,630.00
Grand Total (`) 1,630.00 1,630.00 0.00
0.00 0.00
0.00 1,630.00

GST borne by LIC of India ` 36.68

ONE THOUSAND SIX HUNDRED THIRTY RUPEES AND ZERO PAISE ONLY

Halappa Balaram Gondhalli

Atpo.Kabbur
Tal.Chikodi
Dt.Belgaum

591222 Payment Acknowledgement generated through

Online Portal on 24-Aug-21 Time : 13:21:41.
Mobile: 91******18
Email: ha********li@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!