rsahu667@gm

595205499_1
Collecting Branch : EPS1 Servicing Branch : LIC of India, Bhadrak Branch
LIC OF INDIA,BHADRAK BR OFFICE
Transaction No : 9680326
AT & PO BHADRAK MAIN
Date ( Time ): 02/07/2023 ( 14:25:02 ) ORISSA,756100
Email: BO_593@LICINDIA.COM
Receipt No : PR0968032600012324
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT (REVIVAL)

Received with thanks ` 55,752.52 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Rajendra Sahu

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) (`) (`) (`)
595205499 836 / 25 54,032.00 1 54,032.00 646.36 593
Rajendra Sahu 28/05/2017 YLY 05/23 427.80 646.36 05/24
Yes 05/23 0.00 55,752.52 21AAACL0582H1ZY
04512593 12,00,000

Page Total (`) 54,032.00 54,032.00 646.36

427.80 646.36
0.00 55,752.52
Grand Total (`) 54,032.00 54,032.00 646.36
427.80 646.36
0.00 55,752.52

FIFTY FIVE THOUSAND SEVEN HUNDRED FIFTY TWO RUPEES AND FIFTY TWO PAISE ONLY

Rajendra Sahu
S/O-Yudhisthira Sahu
At/Po-Patnasahi
Dist-Bhadrak

756100 Payment Acknowledgement generated through

Online Portal on 24-Feb-24 Time : 14:42:44.
Mobile: 83******36
Email: rs********67@gmail.com
For Payment related queries-Email: bo_eps1@licindia.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!