Collecting Branch : EPS1 Servicing Branch : LIC of India, Ahmedabad City

Dr.Kasturbhai Chmabers
Transaction No : 14233198
Near Rto Office Subhash Bridge.,Ahmedabad
Date ( Time ): 02/12/2017 ( 12:40:56 ) Ahmedabad,380005
bo_eps1@licindia.com
Receipt No : PR1423319800011718
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received With Thanks ` 4,027.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Ankit Pramodbhai Patel

Towards The Following :

Policy No Plan Inst. Premium No Of Inst Total Premium Tax* Branch

Name Term Mode Due From Late Fee Total Amt Next Due
Agency Code D.O.C. Sum Assured Due To CD Charges Reg. No.
(`) (`) (`)
839043204 820 3,938.00 1 3,938.00 89.00 857
Ankit 20 Hly 11/17 0.00 4,027.00 05/18
02356857 04/05/2015 1,00,000 11/17 0.00

Page Total (`) 3,938.00 3,938.00 89.00

0.00 4,027.00
0.00
Grand Total (`) 3,938.00 3,938.00 89.00
0.00 4,027.00
0.00

FOUR THOUSAND TWENTY SEVEN RUPEES AND ZERO PAISE ONLY

Ankit Pramodbhai Patel Consolidated Stamp Duty paid

A/11, Arbuda Flat,
Kalol-40,
Kalol

382721 Payment Acknowledgement generated through

Online Portal on 02-Dec-17 Time : 12:43:05.
Mobile: 7383833707
Email: mba.ankit.dap@gmail.com

*Tax here indicates Goods and Service Tax (GST) from 01/07/2017 or Service Tax prior to 01/07/2017.

This receipt is electronically generated.

Har Pal Aapke Saath!

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