deepu.

dubey@

596092913_1
Collecting Branch : EPS1 Servicing Branch : LIC of India, Siwan Branch
LIC OF INDIA,SIWAN BR OFFICE
Transaction No : 18401441
NAI BAZAR,GOLPATTI,POST/DIST-
Date ( Time ): 13/09/2022 ( 19:17:54 ) BIHAR,841226
Email: BO_546@LICINDIA.COM
Receipt No : PR1840144100012223
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 4,476.50 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Deepu Dubey

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) (`) (`)
596092913 815 / 20 8,669.00 1 8,669.00 49.25 546
Deepu Dubey 14/08/2014 YLY 08/22 0.00 49.25 02/23
No 08/22 0.00 4,476.50 10AAACL0582H2Z0
04273546 1,50,000

Page Total (`) 8,669.00 8,669.00 49.25

0.00 49.25
0.00 4,476.50
Grand Total (`) 8,669.00 8,669.00 49.25
0.00 49.25
0.00 4,476.50

FOUR THOUSAND FOUR HUNDRED SEVENTY SIX RUPEES AND FIFTY PAISE ONLY

Deepu Dubey
S/O-Late Shiv Kumar Dubey
Vill-Udho Rampur Po-Asaon
Dist-Siwan

841287 Payment Acknowledgement generated through

Online Portal on 22-Jan-24 Time : 09:51:21.
Mobile: 98******23
Email: de********ey@aol.com
For Payment related queries-Email: bo_eps1@licindia.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!