Collecting Center : A001 Branch Code : 621

LIC of India, Mangalore Branch Office I

Transaction No. : 10559513 LIC OF INDIA,MANGALORE-I BRANCH
POPULAR BUILDING, 1ST FLOOR
Date ( Time ): 04/04/2022 ( 14:42:28 ) MANGALORE, 575001
email: BO_621@LICINDIA.COM
Call Center No: 022-68276827

RENEWAL PREMIUM RECEIPT

Received with thanks Rs. 6,120.00 from policyholder Shri/Smt.Parashurama Ustamara

towards the following policy/ies

Policy No Plan Inst. Prem(Rs) No Of Inst Total Premium CGST Branch | Agency
Name Term Mode Due Fr Late Fee SGST*/UTGST Code
Revival D.O.C. Sum Assured Due To CD Chgs + Total Amt Next Due
(Yes/No) Xcharge Reg. No.
633149633 921 5,985.00 1 5,985.00 67.33 621 |05617621
Parashurama U 25 YLY 03/22 0.00 67.33 03/23
No 05/03/2021 1,00,000.00 03/22 0.00 + 0.00 6,119.66 29AAACL0582H2ZH
Page Total (Rs) 5,985.00 5,985.00 67.33
0.00 67.33
0.00 6,119.66
Grand Total (Rs) 5,985.00 5,985.00 67.33
0.00 67.33
0.00 6,119.66

RUPEES SIX THOUSAND ONE HUNDRED TWENTY ONLY

Paid by Cash/Card/Sr :6,120.00
Paid by Cheque :0.00
Cheque No/ChequeDate : 0/

Parashurama Ustamara Consolidated Stamp Duty Paid

Hagribommanalli Po LOA/CSD/280/2022 DTD- 24.02.2022 VALID FROM
Ballari District 14.03.2022 TO 30.09.2022
583212.
Mobile:
For Life Insurance Corporation of India,
St.Milagres Credit Souharadha Co-Op
Ltd.(8200163E)

*SGST also includes cess amount of Rs. 0.00.

GST and Cess borne by LIC of India is Rs 0.00

Har Pal Aapke Sath!!