Collecting Center : A001 Branch Code : CBK1

PCMC, Network Operating Center

Transaction No. : 53286788 1st Floor, Jeevan Seva Annexe,
S.V.Road, Santacruz(W)
Date ( Time ): 30/08/2009 ( 18:49:18 ) Mumbai - 400 054
Ph. : +91-022-1251
e-mail : bo_cbk1@licindia.com

RENEWAL PREMIUM RECEIPT

Received with thanks Rs. 2,434.60 from policyholder Shri/Smt.Smt Satwinder Kaur
towards the following policy/ies

Policy No Plan Inst. Prem(Rs) No Of Inst Total Premium Branch

Name Term Mode Due Fr Late Fee Next Due
Agency Code D.O.C. Sum Assured Due To Total Amt
112249643 75 840.00 1 840.00 11X
Satwinder 20 HLY 03/09 28.00 09/09
62947111 28/03/1997 25,000.00 03/09 868.00
112701632 106 1,546.00 1 1,546.00 11X
Rai Mps 15 QLY 06/09 20.60 09/09
62947111 28/03/2000 50,000.00 06/09 1,566.60
Page Total (Rs) 2,386.00 2,386.00
48.60
2,434.60
Grand Total (Rs) 2,386.00 2,386.00
48.60
2,434.60

RUPEES TWO THOUSAND FOUR HUNDRED THIRTY-FOUR AND SIXTY PAISE ONLY
Paid by Cash :0.00
Paid by Cheque :2,434.60
Cheque No :937252
Cheque Date :30/08/2009

Smt Satwinder Kaur Consolidated Stamp Duty Paid

H-3/12 Malviya Ngr
New Delhi
110017 For Life Insurance Corporation of India,
Sri Ghanshyam Sethi(62947111)

This receipt is subject to realisation of cheque amount.

Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi