Collecting Center : A001 Branch Code : 113

LIC of India, Branch Office 113

Transaction No. : 37468363 Jeevan Tara Bldg. Gate No.4 Ist Floor
5 Parliament Street.
Date ( Time ): 23/07/2017 ( 22:07:30 ) New Delhi, 110001
email: bo_113@licindia.com
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks Rs. 12,652.00 from policyholder Shri/Smt.Leena Rawal

towards the following policy/ies

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

Name Term Mode Due Fr Late Fee Total Amt Next Due
Agency Code D.O.C. Sum Assured Due To CD Chgs Reg. No.
115157970 149 12,652.00 1 12,652.00 0.00 113
RL 77 HLY 07/17 0.00 12,652.00 01/18
86181111 07/07/2009 5,00,000.00 07/17 0.00 07AAACL0582H1ZO
Page Total (Rs) 12,652.00 12,652.00 0.00
0.00 12,652.00
0.00
Grand Total (Rs) 12,652.00 12,652.00 0.00
0.00 12,652.00
0.00

RUPEES TWELVE THOUSAND SIX HUNDRED FIFTY-TWO ONLY

Paid by Cash/Card :0.00
Paid by Cheque :12,652.00
Cheque No :89584
Cheque Date :20/07/2017

Leena Rawal Consolidated Stamp Duty Paid

C-6a/100a AMuSh2016/2967/CR747/M1 w.e.f. 30/11/2016
Janakpuri
New Delhi
110058. For Life Insurance Corporation of India,
Mobile: Smt Punam Batra(86181111)
Email:

*Tax here indicates Goods and Services Tax(GST) from 1 July 2017 or Service Tax prior to 1 July 2017.
This receipt is subject to realisation of cheque amount.

Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi