mdjafar.

hossai

407576762_1
Collecting Branch : EPS1 Servicing Branch : LIC of India, Agartala Brnch I
LIC OF INDIA,AGARTALA BRNCH I
Transaction No : 20346056
PARADISE
Date ( Time ): 22/09/2021 ( 10:20:14 ) AGARTALA, TRIPURA
Email: BO_499@LICINDIA.COM
Receipt No : PR2034605600012122
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 1,00,261.24 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Mdjafar Hossain

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) (`) (`) (`)
407576762 845 / 62 98,055.00 1 98,055.00 1,103.12 499
Md Jafar 28/08/2019 YLY 08/21 0.00 1,103.12 08/22
No 08/21 0.00 1,00,261.24 16AAACL0582H2ZO
07477499 12,50,000

Page Total (`) 98,055.00 98,055.00 1,103.12

0.00 1,103.12
0.00 1,00,261.24
Grand Total (`) 98,055.00 98,055.00 1,103.12
0.00 1,103.12
0.00 1,00,261.24

ONE LAKH TWO HUNDRED SIXTY ONE RUPEES AND TWENTY FOUR PAISE ONLY

Mdjafar Hossain
S/O Abdul Choban
Vill-Nadilag Po-No-2 Chandranagar
Ps-Bishalgarh Sepahijala Tripura

799102 Payment Acknowledgement generated through

Online Portal on 24-Dec-21 Time : 17:13:01.
Mobile: 87******01
Email: md********in@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!

 mdjafar.hossai

492797725_2
Collecting Branch : EPS1 Servicing Branch : LIC of India, Agartala Brnch I
LIC OF INDIA,AGARTALA BRNCH I
Transaction No : 26460695
PARADISE
Date ( Time ): 23/11/2021 ( 07:54:15 ) AGARTALA, TRIPURA
Email: BO_499@LICINDIA.COM
Receipt No : PR2646069500022122
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 35,601.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Mdjafar Hossain

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) (`) (`) (`)
492797725 149 / 71 35,601.00 1 35,601.00 0.00 499
Md. Jafar 25/10/2010 YLY 10/21 0.00 0.00 10/22
No 10/21 0.00 35,601.00 16AAACL0582H2ZO
07477499 5,00,000

Page Total (`) 35,601.00 35,601.00 0.00

0.00 0.00
0.00 35,601.00
Grand Total (`) 35,601.00 35,601.00 0.00
0.00 0.00
0.00 35,601.00

GST borne by LIC of India ` 801.02

THIRTY FIVE THOUSAND SIX HUNDRED ONE RUPEES AND ZERO PAISE ONLY

Mdjafar Hossain
C/O Md Abdul Choban
Vill-Nadilag, Po-No2 Chandranagag
Bishalgarh, Tripura-West

799102 Payment Acknowledgement generated through

Online Portal on 24-Dec-21 Time : 17:13:01.
Mobile: 87******01
Email: md********in@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!