Collecting Center : A001 Branch Code : 766

LIC of India, Salem South Branch Office

Transaction No. : 65962196 LIC OF INDIA,SALEM SOUTH BRANCH OFFICE
30-B,SANNADHI STREET FORT P B NO-87.
Date ( Time ): 08/11/2022 ( 14:35:05 ) , 636001
email: BO_766@LICINDIA.COM
Call Center No: 022-68276827

RENEWAL PREMIUM RECEIPT

Received with thanks Rs. 18,770.00 from policyholder Shri/Smt.K Divya

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.
709813834 814 18,357.00 1 18,357.00 206.52 766 |03672766
Divya K 21 YLY 10/22 0.00 206.52 10/23
No 11/10/2016 3,90,000.00 10/22 0.00 + 0.00 18,770.04 33AAACL0582H1ZT
Page Total (Rs) 18,357.00 18,357.00 206.52
0.00 206.52
0.00 18,770.04
Grand Total (Rs) 18,357.00 18,357.00 206.52
0.00 206.52
0.00 18,770.04

RUPEES EIGHTEEN THOUSAND SEVEN HUNDRED SEVENTY ONLY

Paid by Cash/Card/SR :18,770.04
Paid by Cheque :0.00
Cheque No/ChequeDate : 0/

K Divya Consolidated Stamp Duty Paid

D/O M.Kumaresan, 257/3,Metha Nagar, LOA NO/CSD/390/2022 Dtd - 28.06.2022 valid from
Thiruvakaundanur, 05.07.2022 to 31.01.2023
Salem,
636005.
Mobile: For Life Insurance Corporation of India,
Sri P S Saravanan(03672766)

*SGST also includes cess amount of Rs. 0.00.

GST and Cess borne by LIC of India is Rs 0.00

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

Har Pal Aapke Sath!!