anil.

pnb1695@

533800848_1
Collecting Branch : EPS1 Servicing Branch : LIC of India, Motihari Branch
LIC OF INDIA, BRANCH OFFICE - 536
Transaction No : 13277626
HAZAR JYOTI COMPLEX,,BANK
Date ( Time ): 28/07/2022 ( 22:17:23 ) EAST CHMPARAN,845401
Email: BO_536@LICINDIA.COM
Receipt No : PR1327762600012223
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 1,372.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Himandri Kumari

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) (`) (`) (`)
533800848 75 / 20 1,372.00 1 1,372.00 0.00 536
Himandri Kumari 28/12/2002 QLY 06/22 0.00 0.00 09/22
No 06/22 0.00 1,372.00 10AAACL0582H2Z0
04819536 83,000.00

Page Total (`) 1,372.00 1,372.00 0.00

0.00 0.00
0.00 1,372.00
Grand Total (`) 1,372.00 1,372.00 0.00
0.00 0.00
0.00 1,372.00

GST borne by LIC of India ` 30.88

ONE THOUSAND THREE HUNDRED SEVENTY TWO RUPEES AND ZERO PAISE ONLY

Himandri Kumari
C/O Anil Kumar Chaubey
Areraj, Shanti Nagar
E.Champaran

0 Payment Acknowledgement generated through

Online Portal on 28-Jul-22 Time : 22:18:46.
Mobile: 99******96
Email: an********95@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!