hari.

behera1@

860795525_1
Collecting Branch : EPS1 Servicing Branch : LIC of India, Nowrangapur
LIC OF INDIA,NOWRANGAPUR
Transaction No : 44053762
POST-NOWRANGAPUR.,DIST-
Date ( Time ): 30/03/2024 ( 09:35:37 ) ,764059
Email: BO_59E@LICINDIA.COM
Receipt No : PR4405376200012324
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT (REVIVAL)

Received with thanks ` 941.18 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Swati Behera

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) (`) (`) (`)
860795525 944 / 15 454.00 2 908.00 11.19 59E
Swati Behera 07/07/2022 MLY 02/24 10.80 11.19 04/24
Yes 03/24 0.00 941.18 21AAACL0582H1ZY
0161559E 1,00,000

Page Total (`) 454.00 908.00 11.19

10.80 11.19
0.00 941.18
Grand Total (`) 454.00 908.00 11.19
10.80 11.19
0.00 941.18

NINE HUNDRED FORTY ONE RUPEES AND EIGHTEEN PAISE ONLY

Swati Behera
W/O-Gaya Hari Behera
At-Indira Colony Gandhi Nagar
Po/Dist-Nabarangpur Odisha

764059 Payment Acknowledgement generated through

Online Portal on 30-Mar-24 Time : 09:46:02.
Mobile: 79******00
Email: ha********a1@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!