Collecting

EPS1 Servicing LIC of India,

Branch :
Branch :

Transaction Cuddalore - 607002

No : 43127094

Date ( Time ): 29/03/2021 ( 17:46:46 ) bo_620@licindia.com

Call Center No: 022 6827 6827
Receipt No : PR4312709400012021

RENEWAL PREMIUM RECEIPT

Received with thanks ` 3,873.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : - La
towards the following :

Policy
Plan / Term Inst. Premium No Of Inst Total CGST Branch
No Name
D.O.C. Mode Due From Premium Late SGST/UTGST Next Due
Revival
(Yes/No) Sum Assured Due To Fee Total Amt Reg. No.
Agency
Code (`) CD Charges (`)
(`)
76485717
7 75 / 20 3,873.00 1 3,873.00 0.00 620
R.Name- No 28/03/2005 HLY 03/21 0.00 0.00 09/21
1,25,000 03/21 0.00 3,873.00 33AAACL0582H1ZT
00560620
Page Total (`) 3,873.00 3,873.00 0.00
0.00 0.00
0.00 3,873.00
Grand Total (`) 0.00
3,873.00 3,873.00
0.00 0.00
0.00 3,873.00

GST borne by LIC of India ` 87.14

THREE THOUSAND EIGHT HUNDRED SEVENTY THREE RUPEES AND ZERO PAISE ONLY

*********

Bujanganur Po ,Seeliyur Via

641113 Payment Acknowledgement generated through

Mobile: 99******45 Online Portal on 29-Mar-21 Time : 17:48:32.
Email: ar********ie@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!