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

89-A Anand Estate 1st Floor

Transaction No : 1866405
Above P N Bank Sane Guruji
Date ( Time ): 26/04/2019 ( 12:14:23 ) Mahalaxmi (Byculla) Cbo,400011
bo_eps1@licindia.com
Receipt No : PR0186640500021920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 17,974.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Amit Jagdish Gupta

towards the following :

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

Name Term Mode Due From Late Fee SGST/UTGST Next Due
Agency Code D.O.C. Sum Assured Due To CD Charges Total Amt Reg. No.
(`) (`) (`)
882927912 149 11,034.00 1 11,034.00 0.00 91T
Amit Jagdish 76 YLY 03/19 0.00 0.00 03/20
0077191T 28/03/2007 2,00,000 03/19 0.00 11,034.00

882927913 179 6,940.00 1 6,940.00 0.00 91T

Amit Jagdish 20 YLY 03/19 0.00 0.00 03/20
0077191T 28/03/2007 2,00,000 03/19 0.00 6,940.00

Page Total (`) 17,974.00 17,974.00 0.00

0.00 0.00
0.00 17,974.00
Grand Total (`) 17,974.00 17,974.00 0.00
0.00 0.00
0.00 17,974.00

GST borne by LIC of India ` 404.42

SEVENTEEN THOUSAND NINE HUNDRED SEVENTY FOUR RUPEES AND ZERO PAISE ONLY

Amit Jagdish Gupta

Consolidated Stamp Duty Paid
Bldg No.T/49 4th Floor R.No.404
Nr.Pratiksha Nagar Bus Depot.Sion-Koliwa CSD/328/2019/646/19 DTD.15/02/2019
Mumbai-400022

400022 Payment Acknowledgement generated through

Online Portal on 26-Apr-19 Time : 12:17:14.
Mobile: 9967537597
Email: amitjgupta2002@yahoo.com
This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!