jayachandra.

m
ooli@gmail.co

843879567_1
Collecting Branch : EPS1 Servicing Branch : LIC of India, Nellore Career Ag
LIC OF INDIA,CAREER AGENTS
Transaction No : 5594400
D.NO:15-506, L.C.REDDY
Date ( Time ): 19/05/2022 ( 17:24:12 ) NELLORE,524001
Email: BO_84N@LICINDIA.COM
Receipt No : PR0559440000012223
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 14,003.14 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Mooli Jayachandra Reddy

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) (`) (`) (`)
843879567 815 / 21 13,695.00 1 13,695.00 154.07 84N
Mooli 28/10/2019 HLY 04/22 0.00 154.07 10/22
No 04/22 0.00 14,003.14 37AAACL0582H2ZK
0024484N 5,00,000

Page Total (`) 13,695.00 13,695.00 154.07

0.00 154.07
0.00 14,003.14
Grand Total (`) 13,695.00 13,695.00 154.07
0.00 154.07
0.00 14,003.14

FOURTEEN THOUSAND THREE RUPEES AND FOURTEEN PAISE ONLY

Mooli Jayachandra Reddy

Consolidated Stamp Duty Paid
S/O M Venkata Ramana Reddy
4/19 Rangoripalli Gondipalle LOA/CSD/280/2022 DTD- 24.02.2022 VALID FROM 14.03.2022 TO
Cuddapah

516349 Payment Acknowledgement generated through

Online Portal on 19-May-22 Time : 17:25:53.
Mobile: 88******64
Email: ja********li@gmail.com
For Payment related queries-Email: bo_eps1@licindia.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!