735391229_1

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

LIC OF INDIA,CUDDALORE BRANCH
Transaction No : 22523678
NO.13-A NETHAJI
Date ( Time ): 12/10/2021 ( 08:00:32 ) CUDDALORE,607001
Email: BO_737@LICINDIA.COM
Receipt No : PR2252367800012122
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 1,782.92 through Payment Gateway over the Internet from:

Smt./Ms./Shri : G Kasthuri W/O.R.Gunasekaran

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) (`) (`) (`)
735391229 91 / 16 577.00 3 1,731.00 3.96 737
G Kasthuri 07/03/2009 QLY 03/21 44.00 3.96 12/21
Yes 09/21 0.00 1,782.92 33AAACL0582H1ZT
03524737 30,000.00

Page Total (`) 577.00 1,731.00 3.96

44.00 3.96
0.00 1,782.92
Grand Total (`) 577.00 1,731.00 3.96
44.00 3.96
0.00 1,782.92

GST borne by LIC of India ` 38.94 Late Fee Waived : ` 11.00

ONE THOUSAND SEVEN HUNDRED EIGHTY TWO RUPEES AND NINETY TWO PAISE ONLY

G Kasthuri W/O.R.Gunasekaran
25/15 Sadhasivam Nagar
Thirupapuliyr
Cuddalore

607002 Payment Acknowledgement generated through

Online Portal on 12-Oct-21 Time : 08:03:13.
Mobile: 86******99
Email: gb********94@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!