1

kumardas_hrr
668661209_1

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

LIC OF INDIA,HARIHAR BRANCH
Transaction No : 17483078
LIC BUILDING,P.B.NO.5, SHIMOGA
Date ( Time ): 05/09/2021 ( 15:12:35 ) HARIHARA,577601
Email: BO_62X@LICINDIA.COM
Receipt No : PR1748307800012122
Call Center No: 022 6827 6827

DEPOSIT RECEIPT FOR ADVANCE PREMIUM

Received with thanks ` 2,662.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Kumara Ns

towards Advance Premium payment for the following policy/ies:

Policy No Plan Inst. Premium No Of Inst Total Premium Branch

Name Term Mode Due From CGST Reg. No.
Agency Code D.O.C. Sum Assured Due To SGST/UTGST Total Amt
(`) (`) (`)
668661209 149 2,662.00 1 2,662.00 62X
Kumara.N.S 73 HLY 11/21 0.00 29AAACL0582H2ZH

0044362X 25/11/2013 1,00,000 11/21 0.00 2,662.00

Page Total (`) 2,662.00 2,662.00

0.00
Kumara Ns 0.00 2,662.00
Grand Total (`) 2,662.00 2,662.00
0.00
0.00 2,662.00

GST borne by LIC of India ` 59.90

TWO THOUSAND SIX HUNDRED SIXTY TWO RUPEES AND ZERO PAISE ONLY

The above mentioned Deposit amount for advance premium will get adjusted as Renewal Premium on next due date of
policy/ies.
Kumara Ns
S/O Shivananda.N.L, C-57
Renuka Nilaya,Opp Balaji Rice Mill
A-Block,Vidyanagar,Harihar.

577601 Payment Acknowledgement generated through

Online Portal on 09-Oct-21 Time : 18:12:25.
Mobile: 99******62
Email: ku********rr@yahoo.com
For Payment related queries-Email: bo_eps1@licindia.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!

 1
kumardas_hrr
668661209_2

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

LIC OF INDIA,HARIHAR BRANCH
Transaction No : 2097329
LIC BUILDING,P.B.NO.5, SHIMOGA
Date ( Time ): 19/04/2021 ( 14:37:19 ) HARIHARA,577601
Email: BO_62X@LICINDIA.COM
Receipt No : PR0209732900012122
Call Center No: 022 6827 6827

DEPOSIT RECEIPT FOR ADVANCE PREMIUM

Received with thanks ` 2,662.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Kumara Ns

towards Advance Premium payment for the following policy/ies:

Policy No Plan Inst. Premium No Of Inst Total Premium Branch

Name Term Mode Due From CGST Reg. No.
Agency Code D.O.C. Sum Assured Due To SGST/UTGST Total Amt
(`) (`) (`)
668661209 149 2,662.00 1 2,662.00 62X
Kumara.N.S 73 HLY 05/21 0.00 29AAACL0582H2ZH

0044362X 25/11/2013 1,00,000 05/21 0.00 2,662.00

Page Total (`) 2,662.00 2,662.00

0.00
Kumara Ns 0.00 2,662.00
Grand Total (`) 2,662.00 2,662.00
0.00
0.00 2,662.00

GST borne by LIC of India ` 59.90

TWO THOUSAND SIX HUNDRED SIXTY TWO RUPEES AND ZERO PAISE ONLY

The above mentioned Deposit amount for advance premium will get adjusted as Renewal Premium on next due date of
policy/ies.
Kumara Ns
S/O Shivananda.N.L, C-57
Renuka Nilaya,Opp Balaji Rice Mill
A-Block,Vidyanagar,Harihar.

577601 Payment Acknowledgement generated through

Online Portal on 09-Oct-21 Time : 18:12:25.
Mobile: 99******62
Email: ku********rr@yahoo.com
For Payment related queries-Email: bo_eps1@licindia.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!