136585002_1

Collecting Branch : EPS1 Servicing Branch : LIC of India, Calcutta (CBO-6)

LIC OF INDIA,CALCUTTA (CBO-6)
Transaction No : 20626265
7,COUNCIL HOUSE STREET,2ND
Date ( Time ): 25/09/2021 ( 14:40:20 ) CALCUTTA,700001
Email: BO_412@LICINDIA.COM
Receipt No : PR2062626500012122
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 2,001.04 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Debolina Biswas L/A

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) (`) (`) (`)
136585002 827 / 15 1,957.00 1 1,957.00 22.02 412
Debolina 28/03/2017 QLY 09/21 0.00 22.02 12/21
No 09/21 0.00 2,001.04 19AAACL0582H1ZJ
99665411 1,55,000

Page Total (`) 1,957.00 1,957.00 22.02

0.00 22.02
0.00 2,001.04
Grand Total (`) 1,957.00 1,957.00 22.02
0.00 22.02
0.00 2,001.04

TWO THOUSAND ONE RUPEES AND FOUR PAISE ONLY

Debolina Biswas L/A

Debdas Biswas P
17/1 Prabartak Pally, D P Nagar
Belghoria, Kolkata

700056 Payment Acknowledgement generated through

Online Portal on 25-Sep-21 Time : 14:42:45.
Mobile: 98******00
Email: db********90@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!