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Collecting Bank: CSC eGovernance Services India Ltd.

Branch Code: CBK1 Branch Code : CSC131674750010
PCMC,Network Operating Center, Reciept No. : 3096210
1st Floor,Jeevan Seva Annexe,
Date: 2023-05-31 20:07:39
S.V.Road,Santacruz(W), Mumbai-400054
Ref. No.: LICI2324000074731875
SMS: LICHELP "Policy Number" to 9222492224
CSC Ref. No.: 3151200723569496
Phone: +91-022-1251
Email: bo_cbk1@licindia.com
GSTN: N

RENEWAL PREMIUM RECIEPT

Received With Thanks Rs. 1,052.16 Through CSC EGovernance Services India Ltd. , Retailer ID: 131674750010
Policy Holder: Shri/Smt. Jiten Jadhav
towards the following policy

CGST Branch
Plan Inst. Premium No. of Inst. Total Premium
Policy No.
SGST/UTGST Next Due
Term Mode Due From Late Fee
Name
Total Amt (Rs) Reg. No.
D.O.C Sum Assured (Rs) Due To CDA Charges
Agency Code

915549807 1,029.00 1 1,029.00 11.58 954

Jiten Jadhav Quaterly 12/05/2023 0.00 11.58 12/08/2023

12/05/2023 0.00 23.16 27AAACL0582H1ZM

1,029.00 11.58
Page Total (Rs) 1,029.00 0.00 11.58
0.00 23.16

1,029.00 11.58
Grand Total (Rs) 1,029.00 0.00 11.58
0.00 23.16

In Words (Rupees) : One Thousand Fifty-Two Rupees And Sixteen Paise

Retailer Signature
Retailer ID : 131674750010
Dnyaneshwar Sudam Kardile

LIC PREMIUM PAYMENT FACILITY IS FREE OF COST. POLICY HOLDERS NEED NOT TO PAY ANY EXTRA AMOUNT AS SERVICE CHARGE OF
RETAILER/FRANCHISEES

Retailer : CSC e-Governanace Services India Ltd. 238, Okhla Industrial State, Phase-III, New Delhi-110020
Computer generated receipt. Receipt validity subject to payment realization.
PRINTED ON | 31-05-2023 20:07:41

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