571461837_1

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

LIC OF INDIA,BERHAMPUR BR
Transaction No : 21517418
BHARAT NIVAS,R C CHURCH
Date ( Time ): 02/10/2021 ( 11:45:23 ) DIST-GANJAM,760001
Email: BO_585@LICINDIA.COM
Receipt No : PR2151741800012122
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 3,402.26 through Payment Gateway over the Internet from:

Smt./Ms./Shri : B Sahu
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) (`) (`) (`)
571461837 174 / 20 3,377.00 1 3,377.00 1.93 585
Bhimasen Sahu 28/02/2006 HLY 08/21 21.40 1.93 02/22
Yes 08/21 0.00 3,402.26 21AAACL0582H1ZY
04881585 2,00,000

Page Total (`) 3,377.00 3,377.00 1.93

21.40 1.93
0.00 3,402.26
Grand Total (`) 3,377.00 3,377.00 1.93
21.40 1.93
0.00 3,402.26

GST borne by LIC of India ` 75.98 Late Fee Waived : ` 5.35

THREE THOUSAND FOUR HUNDRED TWO RUPEES AND TWENTY SIX PAISE ONLY

B Sahu
S/O- Rama Sahu
At/Po-Sunathar,
Via-Bhatakumarada, Dist- Ganjam

761003 Payment Acknowledgement generated through

Online Portal on 02-Oct-21 Time : 11:49:03.
Mobile: 99******01
Email: bs********44@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!