Collecting Branch : EPS1 Servicing Branch : LIC of India, Br Office

Transaction No : P B No 3 Pamuru Road

34122804
Kandukur.,Dt Prakasam A P
Date ( Time ): 15/01/2021 ( 11:16:56 ) Kandukur,523105
Email: bo_eps1@licindia.com
Receipt No : PR3412280400012021
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 65,963.66 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Vengalareddy Kasu

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
(Yes/No) Sum Assured Due To CD Charges Total Amt Reg. No.
Agency Code
(`) (`) (`)
846043916
64,044.00 1 64,044.00 757.01 67E
Kasu Vengala 815 / 21
10/12/2015 YLY 12/20 405.64 757.01 12/21
Yes
0115267E 12,00,000 12/20 0.00 65,963.66 37AAACL0582H2ZK

Page Total (`) 64,044.00 64,044.00 757.01

405.64 757.01
0.00 65,963.66
Grand Total (`) 757.01
64,044.00 64,044.00
405.64 757.01
0.00 65,963.66

Late Fee Waived : ` 101.41

SIXTY FIVE THOUSAND NINE HUNDRED SIXTY THREE RUPEES AND SIXTY SIX PAISE ONLY

Vengalareddy Kasu
S/O Brahmareddy Consolidated Stamp Duty Paid
Machavaram Post Vi CSD/113/2020/1936 DTD. 18.09.2020
Chakirla, Kanigiri Mdl

522230 Payment Acknowledgement generated through

Mobile: 90******68 Online Portal on 15-Jan-21 Time : 11:19:58.
Email: ve********86@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!