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

Bharat Nivas R C Church Road

Transaction No : 16725871
Berhampur.,Dist-Ganjam
Date ( Time ): 30/11/2018 ( 20:54:15 ) Berhampur,760001
bo_eps1@licindia.com
Receipt No : PR1672587100021819
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 3,135.02 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Pramod Pradhan

towards the following :

Policy No Plan Inst. Premium No Of Inst Total Premium CGST Branch

Name Term Mode Due From Late Fee SGST/UTGST Next Due
Agency Code D.O.C. Sum Assured Due To CD Charges Total Amt Reg. No.
(`) (`) (`)
574236998 820 3,011.00 1 3,011.00 38.16 585
Pramod 20 QLY 09/18 47.70 38.16 12/18
03555585 28/09/2015 1,50,000 09/18 0.00 3,135.02

Page Total (`) 3,011.00 3,011.00 38.16

47.70 38.16
0.00 3,135.02
Grand Total (`) 3,011.00 3,011.00 38.16
47.70 38.16
0.00 3,135.02

THREE THOUSAND ONE HUNDRED THIRTY FIVE RUPEES AND TWO PAISE ONLY

Pramod Pradhan
S/O:Late Adham Pradhan
At:Rautopeta Street
Berhampur, Dist-Ganjam, Odisha

760001 Payment Acknowledgement generated through

Online Portal on 30-Nov-18 Time : 20:57:45.
Mobile: 9439873217
Email: pr1mo485@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!

 Collecting Branch : EPS1 Servicing Branch : LIC of India, Berhampur Br
Bharat Nivas R C Church Road
Transaction No : 16725871
Berhampur.,Dist-Ganjam
Date ( Time ): 30/11/2018 ( 20:54:15 ) Berhampur,760001
bo_eps1@licindia.com
Receipt No : PR1672587100021819
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 1,696.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Pramod Pradhan

towards the following :

Policy No Plan Inst. Premium No Of Inst Total Premium CGST Branch

Name Term Mode Due From Late Fee SGST/UTGST Next Due
Agency Code D.O.C. Sum Assured Due To CD Charges Total Amt Reg. No.
(`) (`) (`)
571456269 174 1,696.00 1 1,696.00 0.00 585
Pramod Pradhan 20 YLY 11/18 0.00 0.00 11/19
03555585 07/11/2005 40,000.00 11/18 0.00 1,696.00

Page Total (`) 1,696.00 1,696.00 0.00

0.00 0.00
0.00 1,696.00
Grand Total (`) 1,696.00 1,696.00 0.00
0.00 0.00
0.00 1,696.00

GST borne by LIC of India ` 38.16

ONE THOUSAND SIX HUNDRED NINETY SIX RUPEES AND ZERO PAISE ONLY

Pramod Pradhan
S/O:Late Adham Pradhan
At:Rautopeta Street
Berhampur, Dist-Ganjam, Odisha

760001 Payment Acknowledgement generated through

Online Portal on 30-Nov-18 Time : 20:57:45.
Mobile: 9439873217
Email: pr1mo485@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!