We observe

Collecting Branch : EPS1 Servicing Branch : LIC of India, Dondaicha Br 96E

Ranimaa Saheb Plaza. Opp S.T. Stand
Transaction No : 5915475
Dondaicha Tal. - Sindkheda ,Dt Dhule
Date ( Time ): 14/05/2020 ( 22:33:51 ) Dondaicha,425408
bo_eps1@licindia.com
Receipt No : PR0591547500012021
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 3,253.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Rahul Balu Kuwar .

towards the following :

Policy No Plan Inst. Premium No Of Inst Total Premium CGST Branch

Name Term Mode Due From Late Fee SGST/UTGST Next Due
Revival D.O.C. Sum Assured Due To CD Charges Total Amt Reg. No.
(Yes/No) (`) (`) (`)
961064745 174 3,253.00 1 3,253.00 0.00 96E
Rahul Balu 20 HLY 05/20 0.00 0.00 11/20
No 14/11/2005 05/20 0.00 3,253.00 27AAACL0582H1ZM
2,00,000

Page Total (`) 3,253.00 3,253.00 0.00

0.00 0.00
0.00 3,253.00
Grand Total (`) 3,253.00 3,253.00 0.00
0.00 0.00
0.00 3,253.00

GST borne by LIC of India ` 73.20

THREE THOUSAND TWO HUNDRED FIFTY THREE RUPEES AND ZERO PAISE ONLY

Rahul Balu Kuwar .

A/P Balde
Tq Shirpur
Dhule

0 Payment Acknowledgement generated through

Online Portal on 14-May-20 Time : 22:36:26.
Mobile: 8600677752
Email: rahulkuwar88@yahoo.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!