Collecting Branch : EPS1 Servicing Branch : LIC of India, City Br II

Andhra Insurance Buildings

Transaction No : 7288743
Buttaipet.,Masulipatnam
Date ( Time ): 26/05/2020 ( 15:00:39 ) Masulipatnam Ii,521001
Email: bo_eps1@licindia.com
Receipt No : PR0728874300102021
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 4,804.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Vsn Jyothi M

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) (`) (`) (`)
677022785 165 / 16 4,804.00 1 4,804.00 0.00 67N
Mamidi 28/04/2012 YLY 04/20 0.00 0.00 04/21
No 04/20 0.00 4,804.00 37AAACL0582H2ZK
0032567N 1,00,000

Page Total (`) 4,804.00 4,804.00 0.00

0.00 0.00
0.00 4,804.00
Grand Total (`) 4,804.00 4,804.00 0.00
0.00 0.00
0.00 4,804.00

GST borne by LIC of India ` 108.10

FOUR THOUSAND EIGHT HUNDRED FOUR RUPEES AND ZERO PAISE ONLY

Vsn Jyothi M
D/O M.Sri Rama Chandra Murthy,
D.No 3/27/10, Main Road,
Pedana Po Mdl , Krishna Dt Ap

521366 Payment Acknowledgement generated through

Online Portal on 15-Jan-21 Time : 13:15:48.
Mobile: 80******58
Email: mj********90@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!

 Collecting Branch : EPS1 Servicing Branch : LIC of India, City Br II
Andhra Insurance Buildings
Transaction No : 7288743
Buttaipet.,Masulipatnam
Date ( Time ): 26/05/2020 ( 15:00:39 ) Masulipatnam Ii,521001
Email: bo_eps1@licindia.com
Receipt No : PR0728874300102021
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 4,804.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Vsn Jyothi M

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) (`) (`) (`)
677022786 165 / 17 4,804.00 1 4,804.00 0.00 67N
Mamidi 28/04/2012 YLY 04/20 0.00 0.00 04/21
No 04/20 0.00 4,804.00 37AAACL0582H2ZK
0032567N 1,00,000

Page Total (`) 4,804.00 4,804.00 0.00

0.00 0.00
0.00 4,804.00
Grand Total (`) 4,804.00 4,804.00 0.00
0.00 0.00
0.00 4,804.00

GST borne by LIC of India ` 108.10

FOUR THOUSAND EIGHT HUNDRED FOUR RUPEES AND ZERO PAISE ONLY

Vsn Jyothi M
D/O M.Sri Rama Chandra Murthy,
D.No 3/27/10, Main Road,
Pedana Po Mdl , Krishna Dt Ap

521366 Payment Acknowledgement generated through

Online Portal on 15-Jan-21 Time : 13:15:48.
Mobile: 80******58
Email: mj********90@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!

 Collecting Branch : EPS1 Servicing Branch : LIC of India, City Br II
Andhra Insurance Buildings
Transaction No : 7288743
Buttaipet.,Masulipatnam
Date ( Time ): 26/05/2020 ( 15:00:39 ) Masulipatnam Ii,521001
Email: bo_eps1@licindia.com
Receipt No : PR0728874300102021
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 4,804.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Vsn Jyothi M

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) (`) (`) (`)
677022787 165 / 18 4,804.00 1 4,804.00 0.00 67N
Mamidi 28/04/2012 YLY 04/20 0.00 0.00 04/21
No 04/20 0.00 4,804.00 37AAACL0582H2ZK
0032567N 1,00,000

Page Total (`) 4,804.00 4,804.00 0.00

0.00 0.00
0.00 4,804.00
Grand Total (`) 4,804.00 4,804.00 0.00
0.00 0.00
0.00 4,804.00

GST borne by LIC of India ` 108.10

FOUR THOUSAND EIGHT HUNDRED FOUR RUPEES AND ZERO PAISE ONLY

Vsn Jyothi M
D/O M.Sri Rama Chandra Murthy,
D.No 3/27/10, Main Road,
Pedana Po Mdl , Krishna Dt Ap

521366 Payment Acknowledgement generated through

Online Portal on 15-Jan-21 Time : 13:15:48.
Mobile: 80******58
Email: mj********90@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!

 Collecting Branch : EPS1 Servicing Branch : LIC of India, City Br II
Andhra Insurance Buildings
Transaction No : 7288743
Buttaipet.,Masulipatnam
Date ( Time ): 26/05/2020 ( 15:00:39 ) Masulipatnam Ii,521001
Email: bo_eps1@licindia.com
Receipt No : PR0728874300102021
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 4,804.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Vsn Jyothi M

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) (`) (`) (`)
677022789 165 / 19 4,804.00 1 4,804.00 0.00 67N
Mamidi 28/04/2012 YLY 04/20 0.00 0.00 04/21
No 04/20 0.00 4,804.00 37AAACL0582H2ZK
0032567N 1,00,000

Page Total (`) 4,804.00 4,804.00 0.00

0.00 0.00
0.00 4,804.00
Grand Total (`) 4,804.00 4,804.00 0.00
0.00 0.00
0.00 4,804.00

GST borne by LIC of India ` 108.10

FOUR THOUSAND EIGHT HUNDRED FOUR RUPEES AND ZERO PAISE ONLY

Vsn Jyothi M
D/O M.Sri Rama Chandra Murthy,
D.No 3/27/10, Main Road,
Pedana Po Mdl , Krishna Dt Ap

521366 Payment Acknowledgement generated through

Online Portal on 15-Jan-21 Time : 13:15:48.
Mobile: 80******58
Email: mj********90@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!

 Collecting Branch : EPS1 Servicing Branch : LIC of India, City Br II
Andhra Insurance Buildings
Transaction No : 7288743
Buttaipet.,Masulipatnam
Date ( Time ): 26/05/2020 ( 15:00:39 ) Masulipatnam Ii,521001
Email: bo_eps1@licindia.com
Receipt No : PR0728874300102021
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 4,804.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Vsn Jyothi M

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) (`) (`) (`)
677022790 165 / 20 4,804.00 1 4,804.00 0.00 67N
Mamidi 28/04/2012 YLY 04/20 0.00 0.00 04/21
No 04/20 0.00 4,804.00 37AAACL0582H2ZK
0032567N 1,00,000

Page Total (`) 4,804.00 4,804.00 0.00

0.00 0.00
0.00 4,804.00
Grand Total (`) 4,804.00 4,804.00 0.00
0.00 0.00
0.00 4,804.00

GST borne by LIC of India ` 108.10

FOUR THOUSAND EIGHT HUNDRED FOUR RUPEES AND ZERO PAISE ONLY

Vsn Jyothi M
D/O M.Sri Rama Chandra Murthy,
D.No 3/27/10, Main Road,
Pedana Po Mdl , Krishna Dt Ap

521366 Payment Acknowledgement generated through

Online Portal on 15-Jan-21 Time : 13:15:48.
Mobile: 80******58
Email: mj********90@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!

 Collecting Branch : EPS1 Servicing Branch : LIC of India, City Br II
Andhra Insurance Buildings
Transaction No : 7288743
Buttaipet.,Masulipatnam
Date ( Time ): 26/05/2020 ( 15:00:39 ) Masulipatnam Ii,521001
Email: bo_eps1@licindia.com
Receipt No : PR0728874300102021
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 4,804.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Vsn Jyothi M

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) (`) (`) (`)
677022791 165 / 21 4,804.00 1 4,804.00 0.00 67N
Mamidi 28/04/2012 YLY 04/20 0.00 0.00 04/21
No 04/20 0.00 4,804.00 37AAACL0582H2ZK
0032567N 1,00,000

Page Total (`) 4,804.00 4,804.00 0.00

0.00 0.00
0.00 4,804.00
Grand Total (`) 4,804.00 4,804.00 0.00
0.00 0.00
0.00 4,804.00

GST borne by LIC of India ` 108.10

FOUR THOUSAND EIGHT HUNDRED FOUR RUPEES AND ZERO PAISE ONLY

Vsn Jyothi M
D/O M.Sri Rama Chandra Murthy,
D.No 3/27/10, Main Road,
Pedana Po Mdl , Krishna Dt Ap

521366 Payment Acknowledgement generated through

Online Portal on 15-Jan-21 Time : 13:15:48.
Mobile: 80******58
Email: mj********90@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!

 Collecting Branch : EPS1 Servicing Branch : LIC of India, City Br II
Andhra Insurance Buildings
Transaction No : 7288743
Buttaipet.,Masulipatnam
Date ( Time ): 26/05/2020 ( 15:00:39 ) Masulipatnam Ii,521001
Email: bo_eps1@licindia.com
Receipt No : PR0728874300102021
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 4,804.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Vsn Jyothi M

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) (`) (`) (`)
677022792 165 / 22 4,804.00 1 4,804.00 0.00 67N
Mamidi 28/04/2012 YLY 04/20 0.00 0.00 04/21
No 04/20 0.00 4,804.00 37AAACL0582H2ZK
0032567N 1,00,000

Page Total (`) 4,804.00 4,804.00 0.00

0.00 0.00
0.00 4,804.00
Grand Total (`) 4,804.00 4,804.00 0.00
0.00 0.00
0.00 4,804.00

GST borne by LIC of India ` 108.10

FOUR THOUSAND EIGHT HUNDRED FOUR RUPEES AND ZERO PAISE ONLY

Vsn Jyothi M
D/O M.Sri Rama Chandra Murthy,
D.No 3/27/10, Main Road,
Pedana Po Mdl , Krishna Dt Ap

521366 Payment Acknowledgement generated through

Online Portal on 15-Jan-21 Time : 13:15:48.
Mobile: 80******58
Email: mj********90@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!

 Collecting Branch : EPS1 Servicing Branch : LIC of India, City Br II
Andhra Insurance Buildings
Transaction No : 7288743
Buttaipet.,Masulipatnam
Date ( Time ): 26/05/2020 ( 15:00:39 ) Masulipatnam Ii,521001
Email: bo_eps1@licindia.com
Receipt No : PR0728874300102021
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 4,804.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Vsn Jyothi M

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) (`) (`) (`)
677022793 165 / 23 4,804.00 1 4,804.00 0.00 67N
Mamidi 28/04/2012 YLY 04/20 0.00 0.00 04/21
No 04/20 0.00 4,804.00 37AAACL0582H2ZK
0032567N 1,00,000

Page Total (`) 4,804.00 4,804.00 0.00

0.00 0.00
0.00 4,804.00
Grand Total (`) 4,804.00 4,804.00 0.00
0.00 0.00
0.00 4,804.00

GST borne by LIC of India ` 108.10

FOUR THOUSAND EIGHT HUNDRED FOUR RUPEES AND ZERO PAISE ONLY

Vsn Jyothi M
D/O M.Sri Rama Chandra Murthy,
D.No 3/27/10, Main Road,
Pedana Po Mdl , Krishna Dt Ap

521366 Payment Acknowledgement generated through

Online Portal on 15-Jan-21 Time : 13:15:48.
Mobile: 80******58
Email: mj********90@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!

 Collecting Branch : EPS1 Servicing Branch : LIC of India, City Br II
Andhra Insurance Buildings
Transaction No : 7288743
Buttaipet.,Masulipatnam
Date ( Time ): 26/05/2020 ( 15:00:39 ) Masulipatnam Ii,521001
Email: bo_eps1@licindia.com
Receipt No : PR0728874300102021
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 4,804.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Vsn Jyothi M

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) (`) (`) (`)
677022794 165 / 24 4,804.00 1 4,804.00 0.00 67N
Mamidi 28/04/2012 YLY 04/20 0.00 0.00 04/21
No 04/20 0.00 4,804.00 37AAACL0582H2ZK
0032567N 1,00,000

Page Total (`) 4,804.00 4,804.00 0.00

0.00 0.00
0.00 4,804.00
Grand Total (`) 4,804.00 4,804.00 0.00
0.00 0.00
0.00 4,804.00

GST borne by LIC of India ` 108.10

FOUR THOUSAND EIGHT HUNDRED FOUR RUPEES AND ZERO PAISE ONLY

Vsn Jyothi M
D/O M.Sri Rama Chandra Murthy,
D.No 3/27/10, Main Road,
Pedana Po Mdl , Krishna Dt Ap

521366 Payment Acknowledgement generated through

Online Portal on 15-Jan-21 Time : 13:15:48.
Mobile: 80******58
Email: mj********90@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!

 Collecting Branch : EPS1 Servicing Branch : LIC of India, City Br II
Andhra Insurance Buildings
Transaction No : 7288743
Buttaipet.,Masulipatnam
Date ( Time ): 26/05/2020 ( 15:00:39 ) Masulipatnam Ii,521001
Email: bo_eps1@licindia.com
Receipt No : PR0728874300102021
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 4,804.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Vsn Jyothi M

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) (`) (`) (`)
677022795 165 / 25 4,804.00 1 4,804.00 0.00 67N
Mamidi 28/04/2012 YLY 04/20 0.00 0.00 04/21
No 04/20 0.00 4,804.00 37AAACL0582H2ZK
0032567N 1,00,000

Page Total (`) 4,804.00 4,804.00 0.00

0.00 0.00
0.00 4,804.00
Grand Total (`) 4,804.00 4,804.00 0.00
0.00 0.00
0.00 4,804.00

GST borne by LIC of India ` 108.10

FOUR THOUSAND EIGHT HUNDRED FOUR RUPEES AND ZERO PAISE ONLY

Vsn Jyothi M
D/O M.Sri Rama Chandra Murthy,
D.No 3/27/10, Main Road,
Pedana Po Mdl , Krishna Dt Ap

521366 Payment Acknowledgement generated through

Online Portal on 15-Jan-21 Time : 13:15:48.
Mobile: 80******58
Email: mj********90@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!