409189990_1

Collecting Branch : EPS1 Servicing Branch : LIC of India, Kasaba Branch

LIC OF INDIA,KASABA BR OFFICE
Transaction No : 20624221
GARIAHAT MARKET COMPLEX,A &
Date ( Time ): 25/09/2021 ( 14:22:50 ) 212 RASH BEHARI
Email: BO_41E@LICINDIA.COM
Receipt No : PR2062422100012122
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 17,361.02 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Debolina Biswas

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) (`) (`) (`)
409189990 936 / 16 16,979.00 1 16,979.00 191.01 41E
Debolina 28/09/2020 YLY 09/21 0.00 191.01 09/22
No 09/21 0.00 17,361.02 19AAACL0582H1ZJ
1199941E 2,00,000

Page Total (`) 16,979.00 16,979.00 191.01

0.00 191.01
0.00 17,361.02
Grand Total (`) 16,979.00 16,979.00 191.01
0.00 191.01
0.00 17,361.02

SEVENTEEN THOUSAND THREE HUNDRED SIXTY ONE RUPEES AND TWO PAISE ONLY

Debolina Biswas
Consolidated Stamp Duty Paid
C/O Debdas Biswas
17/1 No. Prabartak Pally CSD/70/2021/2092 DATED - 24.06.2021
Kolkata

700056 Payment Acknowledgement generated through

Online Portal on 25-Sep-21 Time : 14:24:50.
Mobile: 90******60
Email: db********as@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!