Collecting Branch : EPS1 Servicing Branch : LIC of India, Jogeshwari (E) Br

LIC OF INDIA, BRANCH OFFICE - 91Q

Transaction No : 8383335
SATELITE CLASSIC BLDG., 1ST/2ND
Date ( Time ): 11/06/2021 ( 23:01:06 ) MUMBAI.,400060
Email: BO_91Q@LICINDIA.COM
Receipt No : PR0838333500022122
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 49,213.94 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Saurabh R. Chaudhari

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) (`) (`) (`)
896168608 836 / 25 24,216.00 1 24,216.00 272.43 91Q
Saurabh R. 07/06/2017 YLY 06/21 0.00 272.43 06/22
No 06/21 0.00 24,760.86 27AAACL0582H1ZM
0041691Q 5,00,000

896168609 836 / 25 23,915.00 1 23,915.00 269.04 91Q

Saurabh R. 07/06/2017 YLY 06/21 0.00 269.04 06/22
No 06/21 0.00 24,453.08 27AAACL0582H1ZM
0109491Q 5,00,000

Page Total (`) 48,131.00 48,131.00 541.47

0.00 541.47
0.00 49,213.94
Grand Total (`) 48,131.00 48,131.00 541.47
0.00 541.47
0.00 49,213.94

FORTY NINE THOUSAND TWO HUNDRED THIRTEEN RUPEES AND NINETY FOUR PAISE ONLY

Saurabh R. Chaudhari
Consolidated Stamp Duty Paid
Flat No. 4, Nav Kundan Apt,
Jesal Park Rd Bander Wadi, CSD/113/2020/1936 DTD. 18.09.2020
Bhayander East , Thane.

401105 Payment Acknowledgement generated through

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Email: sa********82@gmail.com
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