We observe

Collecting Branch : EPS1 Servicing Branch : LIC of India, Kolkata Cb No 16

H B Annexe 4 C R Avenue 2nd Floor.
Transaction No : 21764850
Calcutta,
Date ( Time ): 27/09/2020 ( 20:47:36 ) Calcutta,700072
bo_eps1@licindia.com
Receipt No : PR2176485000022021
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 4,043.42 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Basudha Biswas

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) (`) (`) (`)
417070362 14 1,995.00 1 1,995.00 0.00 41J
Basudha 25 HLY 09/20 0.00 0.00 03/21
No 28/09/2006 09/20 0.00 1,995.00 19AAACL0582H1ZJ
1,05,000

404454742 815 998.00 2 1,996.00 23.03 576

Basudha 20 MLY 08/20 6.36 23.03 10/20
Yes 18/03/2019 09/20 0.00 2,048.42 19AAACL0582H1ZJ
2,00,000

Page Total (`) 2,993.00 3,991.00 23.03

6.36 23.03
0.00 4,043.42
Grand Total (`) 2,993.00 3,991.00 23.03
6.36 23.03
0.00 4,043.42

GST borne by LIC of India ` 44.88

FOUR THOUSAND FORTY THREE RUPEES AND FORTY TWO PAISE ONLY

Basudha Biswas
251/A/24,Netaji Subhas Chandra Bose Road
Naktala,Kolkata

700047 Payment Acknowledgement generated through

Online Portal on 27-Sep-20 Time : 20:48:56.
Mobile: 90******64
Email: ba********87@gmail.com
This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!