Collecting Center : A001 Branch Code : 585

LIC of India, Berhampur Br Office-I

Transaction No. : 97174580 LIC OF INDIA,BERHAMPUR BR OFFICE-I
BHARAT NIVAS,R C CHURCH ROAD
Date ( Time ): 08/03/2024 ( 14:13:19 ) DIST-GANJAM, 760001
email: BO_585@LICINDIA.COM
Call Center No: 022-68276827

RENEWAL PREMIUM RECEIPT

Received with thanks Rs. 6,085.00 from policyholder Shri/Smt.Ashoka Kumar Mahankuda
towards the following policy/ies

Policy No Plan Inst. Prem(Rs) No Of Inst Total Premium CGST Branch | Agency
Name Term Mode Due Fr Late Fee SGST*/UTGST Code
Revival D.O.C. Sum Assured Due To CD Chgs + Total Amt Next Due
(Yes/No) Xcharge Reg. No.
857288653 914 2,922.00 2 5,844.00 74.08 585 |07331585
Mahankuda Ak 21 QLY 11/23 92.50 74.08 05/24
Yes 23/08/2021 2,45,000.00 02/24 0.00 + 0.00 6,084.66 21AAACL0582H1ZY
Page Total (Rs) 2,922.00 5,844.00 74.08
92.50 74.08
0.00 6,084.66
Grand Total (Rs) 2,922.00 5,844.00 74.08
92.50 74.08
0.00 6,084.66

RUPEES SIX THOUSAND EIGHTY-FIVE ONLY

Paid by Cash/Card/SR :6,084.66
Paid by Cheque :0.00
Cheque No/ChequeDate : 0/

Ashoka Kumar Mahankuda Consolidated Stamp Duty Paid

At/Po-Dengadi LOA/CSD/16/2023/4476 dtd 06/11/2023 valid from
Via-Kankorada 10/11/2023 to 30/06/2024
Dist- Ganjam Odisha
761144.
Mobile: For Life Insurance Corporation of India,
Sri Rabi Prakash Mishra(0071558T)

*SGST also includes cess amount of Rs. 0.00.

GST and Cess borne by LIC of India is Rs 0.00

Check the authenticity of the receipt using following url: https://services.licindia.in/validatereceipt

Har Pal Aapke Sath!!