Subhajannala2

0@gmail.com

719902451_1
Collecting Branch : EPS1 Servicing Branch : LIC of India, Ambattur Br Office
LIC OF INDIA,AMBATTUR BR OFFICE
Transaction No : 31933068
87,NORTH PARK
Date ( Time ): 10/01/2022 ( 07:32:04 ) CHENNAI,600053
Email: BO_71G@LICINDIA.COM
Receipt No : PR3193306800012122
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 27,893.78 through Payment Gateway over the Internet from:

Smt./Ms./Shri : D Shubhashini
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) (`) (`) (`)
719902451 149 / 73 6,569.00 4 26,276.00 123.39 71G
D Shubhashini 13/08/2012 QLY 02/21 1,371.00 123.39 02/22
Yes 11/21 0.00 27,893.78 33AAACL0582H1ZT
0160971G 5,00,000

Page Total (`) 6,569.00 26,276.00 123.39

1,371.00 123.39
0.00 27,893.78
Grand Total (`) 6,569.00 26,276.00 123.39
1,371.00 123.39
0.00 27,893.78

GST borne by LIC of India ` 591.20

TWENTY SEVEN THOUSAND EIGHT HUNDRED NINETY THREE RUPEES AND SEVENTY EIGHT
PAISE ONLY

D Shubhashini
Consolidated Stamp Duty Paid
9/32 Sriram Nagar 6th Cross Street
Behind Jaya School CSD/70/2021/2092 DATED - 24.06.2021
Thirunindravur Chennai

602024 Payment Acknowledgement generated through

Online Portal on 10-Jan-22 Time : 07:36:40.
Mobile: 95******34
Email: Su********20@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!