skc1986@live.

659583863_1
Collecting Branch : EPS1 Servicing Branch : LIC of India, Gajuwaka Branch
LIC OF INDIA,BRANCH OFFICE
Transaction No : 10663358
HERO SHOWROOM
Date ( Time ): 11/07/2023 ( 09:50:45 ) SRI NAGAR,
Email: BO_69E@LICINDIA.COM
Receipt No : PR1066335800012324
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 54,539.11 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Vijayuma Chandra Mouli Nalla

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) (`) (`) (`)
659583863 915 / 25 51,916.00 1 51,916.00 695.03 69E
Vijayuma 28/03/2021 YLY 03/23 1,233.05 695.03 03/24
Yes 03/23 0.00 54,539.11 37AAACL0582H2ZK
0208469E 11,00,000

Page Total (`) 51,916.00 51,916.00 695.03

1,233.05 695.03
0.00 54,539.11
Grand Total (`) 51,916.00 51,916.00 695.03
1,233.05 695.03
0.00 54,539.11

FIFTY FOUR THOUSAND FIVE HUNDRED THIRTY NINE RUPEES AND ELEVEN PAISE ONLY

Vijayuma Chandra Mouli Nalla

Consolidated Stamp Duty Paid
D.No J-505, Comfort Homes
Puru Shothapuram, Sujatha Nagar LOA/CSD/48/2023/2582 DATED 22.05.2023 for Rs 3 Cr Valid
Visakhapatnam

530051 Payment Acknowledgement generated through

Online Portal on 11-Jul-23 Time : 09:52:43.
Mobile: 99******89
Email: sk********86@live.com
For Payment related queries-Email: bo_eps1@licindia.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!