476441393_1

Collecting Branch : EPS1 Servicing Branch : LIC of India, Subhash Nagar IV

LIC OF INDIA,SUBHASH NAGAR IV
Transaction No : 26834214
BRANCH OFFICE IV,SUBHASH
Date ( Time ): 26/11/2021 ( 10:46:17 ) JAIPUR, RAJASTHAN,0
Email: BO_1242@LICINDIA.COM
Receipt No : PR2683421400012122
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 3,884.48 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Laxmi Narayan Sharma

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) (`) (`) (`)
476441393 815 / 23 3,799.00 1 3,799.00 42.74 1242
Laxmi Narayan 01/11/2013 HLY 11/21 0.00 42.74 05/22
No 11/21 0.00 3,884.48 08AAACL0582H2ZL
123751242 1,50,000

Page Total (`) 3,799.00 3,799.00 42.74

0.00 42.74
0.00 3,884.48
Grand Total (`) 3,799.00 3,799.00 42.74
0.00 42.74
0.00 3,884.48

THREE THOUSAND EIGHT HUNDRED EIGHTY FOUR RUPEES AND FORTY EIGHT PAISE ONLY

Laxmi Narayan Sharma

P.No-48, Ganesh Nagar,Behind
Kumawat School,Near E.S.I Hospitel
Sodala,Jaipur. Raj

302019 Payment Acknowledgement generated through

Online Portal on 26-Nov-21 Time : 10:50:42.
Mobile: 93******92
Email: la********19@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!