rajmallisuresh

717748856_1
Collecting Branch : EPS1 Servicing Branch : LIC of India, Thiruvottiyur Br
THIRUVOTTIYUR BRANCH OFFICE
Transaction No : 19421206
NO.142-144,
Date ( Time ): 23/09/2022 ( 16:12:27 ) CHENNAI,600081
Email: BO_71D@LICINDIA.COM
Receipt No : PR1942120600012223
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 5,505.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Balasubramaniam Sureshkumar

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) (`) (`) (`)
717748856 149 / 66 5,505.00 1 5,505.00 0.00 71D
B Sureshkumar 20/09/2005 YLY 09/22 0.00 0.00 09/23
No 09/22 0.00 5,505.00 33AAACL0582H1ZT
0007771D 1,00,000

Page Total (`) 5,505.00 5,505.00 0.00

0.00 0.00
0.00 5,505.00
Grand Total (`) 5,505.00 5,505.00 0.00
0.00 0.00
0.00 5,505.00

GST borne by LIC of India ` 123.86

FIVE THOUSAND FIVE HUNDRED FIVE RUPEES AND ZERO PAISE ONLY

Balasubramaniam Sureshkumar
Consolidated Stamp Duty Paid
7/93c/5, Village Street
T.S.Gopal Nagar LOA NO/CSD/390/2022 Dtd - 28.06.2022 valid from 05.07.2022 to
Thiruvottiyur, Chennai

600019 Payment Acknowledgement generated through

Online Portal on 23-Sep-22 Time : 16:18:07.
Mobile: 90******44
Email: ra********sh@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!