manjunathub@

Collecting Branch : EPS1 Servicing Branch : LIC of India, Bangalore(St.

LIC OF INDIA,BANGALORE(ST.
Transaction No : 14256331
ST MARKS ROAD
Date ( Time ): 06/08/2022 ( 19:51:43 ) BANGALORE,560001
Email: BO_309@LICINDIA.COM
Receipt No : PR1425633100012223
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 7,647.28 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Manjunath Bhimaraya Uppar

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) (`) (`) (`)
365446656 815 / 16 7,479.00 1 7,479.00 84.14 309
Manjunath U B 11/02/2015 HLY 08/22 0.00 84.14 02/23
No 08/22 0.00 7,647.28 29AAACL0582H2ZH
01631309 2,00,000

Page Total (`) 7,479.00 7,479.00 84.14

0.00 84.14
0.00 7,647.28
Grand Total (`) 7,479.00 7,479.00 84.14
0.00 84.14
0.00 7,647.28

SEVEN THOUSAND SIX HUNDRED FORTY SEVEN RUPEES AND TWENTY EIGHT PAISE ONLY

Manjunath Bhimaraya Uppar

Consolidated Stamp Duty Paid
No.34, 5th Cross, Kuvempu College
Road,Mallasandra, T Dasarahalli, LOA NO/CSD/390/2022 Dtd - 28.06.2022 valid from 05.07.2022 to
Bengaluru

560057 Payment Acknowledgement generated through

Online Portal on 06-Aug-22 Time : 19:54:00.
Mobile: 96******65
Email: ma********ub@yahoo.com
For Payment related queries-Email: bo_eps1@licindia.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!