bajrangtextiles

888@gmail.co

122451940_1
Collecting Branch : EPS1 Servicing Branch : LIC of India, Branch Unit No
LIC OF INDIA,BO 123
Transaction No : 33071720
10, BHARAT BASE
Date ( Time ): 19/01/2022 ( 11:57:14 ) NEW DELHI,110002
Email: BO_123@LICINDIA.COM
Receipt No : PR3307172000012122
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 2,887.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Sri Kamal Kumar Bansal

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) (`) (`) (`)
122451940 149 / 64 2,887.00 1 2,887.00 0.00 123
Sri Kamal Kumar 08/01/2004 QLY 01/22 0.00 0.00 04/22
No 01/22 0.00 2,887.00 07AAACL0582H1ZO
73511111 2,00,000

Page Total (`) 2,887.00 2,887.00 0.00

0.00 0.00
0.00 2,887.00
Grand Total (`) 2,887.00 2,887.00 0.00
0.00 0.00
0.00 2,887.00

GST borne by LIC of India ` 64.96

TWO THOUSAND EIGHT HUNDRED EIGHTY SEVEN RUPEES AND ZERO PAISE ONLY

Sri Kamal Kumar Bansal

4520, Iiird Floor,
Krishna Bazar, Cloth Market,
Delhi

110006 Payment Acknowledgement generated through

Online Portal on 19-Jan-22 Time : 11:58:36.
Mobile: 93******67
Email: ba********88@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!