uc sl Services, Collecting Branch: EPS1 Servicing Branch : LIC OF INDIABRANCH ‘4st FLOOR, WING SAI CLASSIC, 90 FEET ROAD,NEAR PALM ACRES Date (Time): 04/09/2019 ( 11:95:41 ) Mumbai,¢o0081 bbo_epst@licincia.com Receipt No: PR2580087600011819 Hebbel Poza test ‘Transaction No : 25300676 RENEWAL PREMIUM RECEIPT Received with thanks % 1,531.00 through Payment Gateway over the Internet from: Smt/MsJShei Yogesh Shyam Joshi towards the following : Policy No Plan Inst, Premium | No Ofinst ] Total Premium ] _ OGST Branch Name Term Mode Due From | LateFee | sGsTiuTast} Next Due ‘Agency Code] 0.0.0. | SumAssured | dueto | coCharges | Total Amt ®) ® ® 1883389652 165 1,581.00 1 4,831.00 900 ak Yogesh Shyam} 35, uy ose 0.00 0.00 os9 095988 | o1iosi2009 | 1,25,000 ong 0.00 1,531.00 Page Total (®) 41,531.00 41,531.00 0.09 0.00 0.09 0.00] 1,531.00] Grand Total (®) 1,531.00 1,531.00 0. 0.00, 0.0 0.00] 1,531.0 GST borne by LIC of India € 34.44 (ONE THOUSAND FIVE HUNDRED THIRTY ONE RUPEES AND ZERO PAISE ONLY Yogesh Shyam Joshi Mahalaxmi Darshan, Flat No 6, Ground Floor, Aaptewadi Ramnagar Kulgaon Badlapur E Near Sakshi Park 421803 Payment Acknowledgement generated through ine: pense TS) COntine Portal on Od-Adar-19 Time" 11:37-08. Email: yioshiS6@ yahoo.com This receipt is electronically generated and no signature is required. Har Pal Aapke Saath!