241985433_1

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

LIC OF INDIA,DEORIA BRANCH
Transaction No : 11578002
RAGHAV NAGAR.,DEORIA
Date ( Time ): 10/07/2021 ( 17:13:35 ) ,0
Email: BO_282@LICINDIA.COM
Receipt No : PR1157800200012122
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 769.13 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Indra Pandey

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) (`) (`) (`)
241985433 91 / 16 762.00 1 762.00 0.54 282
Indra Pandey 09/09/2009 QLY 06/21 6.05 0.54 09/21
Yes 06/21 0.00 769.13 09AAACL0582HFZ6
05720212 45,000.00

Page Total (`) 762.00 762.00 0.54

6.05 0.54
0.00 769.13
Grand Total (`) 762.00 762.00 0.54
6.05 0.54
0.00 769.13

GST borne by LIC of India ` 17.14

SEVEN HUNDRED SIXTY NINE RUPEES AND THIRTEEN PAISE ONLY

Indra Pandey
W/O Sri Gyanendra Kumar Pandey,
Vill. Pandeypur, Po. Kushahri,
Dt.Dewriya U.P

274001 Payment Acknowledgement generated through

Online Portal on 10-Jul-21 Time : 17:14:43.
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Email: gk********82@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!