Collecting Branch : EPS1 Branch Code : EPS1

PCMC, Network Operating Center

Transaction No. : PR0016018800011011 1st Floor, Jeevan Seva Annexe,
S.V.Road, Santacruz(W)
Date ( Time ): 19/04/2010 ( 17:11:56 ) Mumbai - 400 054
Ph. : +91-022-1251
e-mail : bo_eps1@licindia.com

RENEWAL PREMIUM RECEIPT

Received with thanks Rs. 4,834.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Sureshkumar Tulsiram Dayma

Towards the following

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
903049997 75 4,834.00 1 4,834.00 922
Dayma S.T 20 QLY 04/10 0.00 07/10
01867922 11/07/2007 3,00,000.00 04/10 4,834.00
Page Total (Rs) 4,834.00 4,834.00
0.00
4,834.00
Grand Total (Rs) 4,834.00 4,834.00
0.00
4,834.00

RUPEES FOUR THOUSAND EIGHT HUNDRED THIRTY-FOUR ONLY

Sureshkumar Tulsiram Dayma

3/1 Bmc Colony Shivaji
Nagar Bandra [E].
Mumbai.
400051

This receipt is electronically generated and is digitally signed.

Signature Not Verified

Digitally signed by REKHA VARSHNEY
Date: April 19, 2010 5:11:56 PM IST
Reason: Premium Receipt
Location: LIC OF INDIA

Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi

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