Collecting Branch : EPS1 Servicing Branch : LIC of India, Hissar Br Office -

Urban Estate - 2
Transaction No : 5842220
Behind Commercial Exchange.,Hissar
Date ( Time ): 14/05/2020 ( 10:36:13 ) Hissar,0
bo_eps1@licindia.com
Receipt No : PR0584222000012021
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 8,778.16 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Ravinder Singh

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
Revival D.O.C. Sum Assured Due To CD Charges Total Amt Reg. No.
(Yes/No) (`) (`) (`)
504858975 836 8,585.00 1 8,585.00 96.58 17M
Yuvraj Singh 21 HLY 05/20 0.00 96.58 11/20
No 15/05/2017 05/20 0.00 8,778.16 06AAACL0582H1ZQ
3,20,000

Page Total (`) 8,585.00 8,585.00 96.58

0.00 96.58
0.00 8,778.16
Grand Total (`) 8,585.00 8,585.00 96.58
0.00 96.58
0.00 8,778.16

EIGHT THOUSAND SEVEN HUNDRED SEVENTY EIGHT RUPEES AND SIXTEEN PAISE ONLY

Ravinder Singh
S/O Sh. Satbir Singh Dhanda
Vpo Mirchpur Teh. Narnound
Distt. Hissar

125001 Payment Acknowledgement generated through

Online Portal on 14-May-20 Time : 10:46:27.
Mobile: 9466013166
Email: ravinderarya2020@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!