k.p.

gorakhpur

297273821_1
Collecting Branch : EPS1 Servicing Branch : LIC of India, Gorakhpur Br 281
LIC OF INDIA,GORAKHPUR BR I 281
Transaction No : 29983479
NEAR KHAKI BABA
Date ( Time ): 25/12/2021 ( 10:36:49 ) UP,273001
Email: BO_281@LICINDIA.COM
Receipt No : PR2998347900012122
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 9,569.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Vandana Singh

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) (`) (`) (`)
297273821 75 / 20 9,569.00 1 9,569.00 0.00 281
Vandana Singh 28/11/2012 YLY 11/21 0.00 0.00 11/22
No 11/21 0.00 9,569.00 09AAACL0582HFZ6
08395281 1,50,000

Page Total (`) 9,569.00 9,569.00 0.00

0.00 0.00
0.00 9,569.00
Grand Total (`) 9,569.00 9,569.00 0.00
0.00 0.00
0.00 9,569.00

GST borne by LIC of India ` 215.30

NINE THOUSAND FIVE HUNDRED SIXTY NINE RUPEES AND ZERO PAISE ONLY

Vandana Singh
Consolidated Stamp Duty Paid
W/O Sri K.P.Singh
H.No-10-I, Indira Nagar, Rasoolpur CSD/70/2021/2092 DATED - 24.06.2021
Gorakhpur

273001 Payment Acknowledgement generated through

Online Portal on 25-Dec-21 Time : 10:38:10.
Mobile: 70******19
Email: k.********ur@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!