Collecting Branch : EPS1 Servicing Branch : LIC of India, Ongole Branch

D No 37 1 1 C South Extn
Transaction No : 12689538
Padmavati Bldg P B No 32 Trunk
Date ( Time ): 09/07/2020 ( 17:23:24 ) Ongole,523001
Email: bo_eps1@licindia.com
Receipt No : PR1268953800012021
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 12,246.02 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Bhagyalakshmi K
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) (`) (`) (`)
846169568 814 / 21 11,657.00 1 11,657.00 156.06 305
Kasu Bhagya 28/03/2016 YLY 03/20 276.90 156.06 03/21
Yes 03/20 0.00 12,246.02 37AAACL0582H2ZK
01705305 2,50,000

Page Total (`) 11,657.00 11,657.00 156.06

276.90 156.06
0.00 12,246.02
Grand Total (`) 11,657.00 11,657.00 156.06
276.90 156.06
0.00 12,246.02

TWELVE THOUSAND TWO HUNDRED FORTY SIX RUPEES AND TWO PAISE ONLY

Bhagyalakshmi K
W/O Vengala Reddy
Machavaram Post
Kanigiri Mdl., Prakasam Dist.

523247 Payment Acknowledgement generated through

Online Portal on 15-Jan-21 Time : 11:34:28.
Mobile: 73******80
Email: ve********bi@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!