Collecting Center : E001 Branch Code : 867

LIC of India, Valsad Branch Office No-I

Transaction No. : 46130539 LIC OF INDIA,VALSAD BR OFFICE NO-I
OPP MAIN POST OFFICE,P B NO-5
Date ( Time ): 22/08/2022 ( 19:59:01 ) VALSAD, 396001
email: BO_867@LICINDIA.COM
Call Center No: 022-68276827

RENEWAL PREMIUM RECEIPT

Received with thanks Rs. 9,700.00 from policyholder Shri/Smt.Bantikumar Naranbhai Tandel
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.
864661459 149 9,700.00 1 9,700.00 0.00 867 |02794867
B N Tandel Bnt 77 YLY 07/22 0.00 0.00 07/23
No 23/07/2008 2,00,000.00 07/22 0.00 + 0.00 9,700.00 24AAACL0582H2ZR
Page Total (Rs) 9,700.00 9,700.00 0.00
0.00 0.00
0.00 9,700.00
Grand Total (Rs) 9,700.00 9,700.00 0.00
0.00 0.00
0.00 9,700.00

RUPEES NINE THOUSAND SEVEN HUNDRED ONLY

Paid by Cash/Card/SR :9,700.00
Paid by Cheque :0.00
Cheque No/ChequeDate : 0/

Bantikumar Naranbhai Tandel Consolidated Stamp Duty Paid

Kosamba,Pardhi Falia-Apar, LOA NO/CSD/390/2022 Dtd - 28.06.2022 valid from
Rupali Street,Tq/Dist.Valsad. 05.07.2022 to 31.01.2023
396001.
Mobile: 919426847008
For Life Insurance Corporation of India,
SHAILESH C SHUKLA(416838)

*SGST also includes cess amount of Rs. 0.00.

GST and Cess borne by LIC of India is Rs 218.26

Check the authenticity of the receipt using following url: https://services.licindia.in/validatereceipt

Har Pal Aapke Sath!!