Collecting Branch : EPS1 Servicing Branch : 11B

E-mail : bo_eps1@licindia.com LIC of India, Delhibranch Unit No-11B

Phone : +91-022-1251 JEEVAN PRAGATI BUILDING
I & II FLOOR,PLOT NO. 6
Transaction No. : PR0540640000011516 DISTRICT CENTER LAXMI NAGAR
Delhi
Date ( Time ): 13/08/2015 ( 12:55:30 ) 110092

RENEWAL PREMIUM RECEIPT

Received with thanks Rs. 6887.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Manish Jain

Towards the following

Policy No Plan Inst. Prem(Rs) No Of Inst Total Premium Service Tax Branch
Name Term Mode Due Fr Late Fee Edu Cess Next Due
Agency Code D.O.C. Sum Assured Due To Total Amt
126683669 14 6,887.00 1 6,887.00 0.00 11B
Manish 15 YLY 08/15 0.00 0.00 08/16
0027211B 12/08/2013 1,00,000.00 08/15 6,887.00
Page Total (Rs) 6,887.00 6,887.00 0.00
0.00 0.00
6,887.00
Grand Total (Rs) 6,887.00 6,887.00 0.00
0.00 0.00
6,887.00

RUPEES SIX THOUSAND EIGHT HUNDRED EIGHTY-SEVEN ONLY

Manish Jain A.Mu.Sh.2015/CR 242/M-1 Dated 15/05/2015

H.No-279 Gali No-16
Balbir Nagar Extn
Delhi.
110032

This receipt is electronically generated.

Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi

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