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

No.1 (Old No.8/9) 1st Cross

Transaction No : 8729790
3rd Main Road Chamrajpet
Date ( Time ): 05/06/2020 ( 15:55:59 ) Bangalore,560018
bo_eps1@licindia.com
Receipt No : PR0872979000012021
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 7,904.96 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Krishne Gowda C

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
Revival D.O.C. Sum Assured Due To CD Charges Total Amt Reg. No.
(Yes/No) (`) (`) (`)
615473610 149 3,793.00 2 7,586.00 24.33 61A
C Krishne 69 QLY 12/19 270.30 24.33 06/20
Yes 18/03/2008 03/20 0.00 7,904.96 29AAACL0582H2ZH
2,00,000

Page Total (`) 3,793.00 7,586.00 24.33

270.30 24.33
0.00 7,904.96
Grand Total (`) 3,793.00 7,586.00 24.33
270.30 24.33
0.00 7,904.96

GST borne by LIC of India ` 170.68

SEVEN THOUSAND NINE HUNDRED FOUR RUPEES AND NINETY SIX PAISE ONLY

Krishne Gowda C
Consolidated Stamp Duty Paid
S/O.R.Chandrappa, Sri Ramanilaya,
Lower Huttha, Shyadri Extension, CSD/323/2020/802/2020 DTD.20/02/2020
B.H.Road, Bhadravathi,Shimoga Dist

577301 Payment Acknowledgement generated through

Online Portal on 05-Jun-20 Time : 15:57:47.
Mobile: 95******16
Email: ck********vt@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!