987958624_1

Collecting Branch : EPS1 Servicing Branch : LIC of India, Hingoli Branch

LIC OF INDIA,HINGOLI BRANCH
Transaction No : 40514946
STATION ROAD,,NEAR POST
Date ( Time ): 09/03/2021 ( 09:23:52 ) HINGOLI,431513
Email: BO_95H@LICINDIA.COM
Receipt No : PR4051494600022021
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 9,066.50 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Amolkumar Digambar Kshirsagar

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) (`) (`) (`)
987958624 807 / 21 8,867.00 1 8,867.00 99.75 95H
Pramila 06/09/2013 HLY 03/21 0.00 99.75 09/21
No 03/21 0.00 9,066.50 27AAACL0582H1ZM
0179895H 5,00,000

Page Total (`) 8,867.00 8,867.00 99.75

0.00 99.75
0.00 9,066.50
Grand Total (`) 8,867.00 8,867.00 99.75
0.00 99.75
0.00 9,066.50

NINE THOUSAND SIXTY SIX RUPEES AND FIFTY PAISE ONLY

Amolkumar Digambar Kshirsagar

College Road, Shastri Nagar ,
Basmathnagar
Dist.Hingoli

431512 Payment Acknowledgement generated through

Online Portal on 16-Nov-21 Time : 19:54:12.
Mobile: 98******17
Email: ad********il@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!

 987958624_2
Collecting Branch : EPS1 Servicing Branch : LIC of India, Hingoli Branch
LIC OF INDIA,HINGOLI BRANCH
Transaction No : 20711309
STATION ROAD,,NEAR POST
Date ( Time ): 18/09/2020 ( 20:01:58 ) HINGOLI,431513
Email: BO_95H@LICINDIA.COM
Receipt No : PR2071130900022021
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 9,066.50 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Amolkumar Digambar Kshirsagar

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) (`) (`) (`)
987958624 807 / 21 8,867.00 1 8,867.00 99.75 95H
Pramila 06/09/2013 HLY 09/20 0.00 99.75 03/21
No 09/20 0.00 9,066.50 27AAACL0582H1ZM
0179895H 5,00,000

Page Total (`) 8,867.00 8,867.00 99.75

0.00 99.75
0.00 9,066.50
Grand Total (`) 8,867.00 8,867.00 99.75
0.00 99.75
0.00 9,066.50

NINE THOUSAND SIXTY SIX RUPEES AND FIFTY PAISE ONLY

Amolkumar Digambar Kshirsagar

College Road, Shastri Nagar ,
Basmathnagar
Dist.Hingoli

431512 Payment Acknowledgement generated through

Online Portal on 16-Nov-21 Time : 19:54:12.
Mobile: 98******17
Email: ad********il@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!