Collecting Branch : EPS1 Servicing Branch : LIC of India, Suri Branch Office

Tagore Road Near Bus Stand.

Transaction No : 10024977
P O Suri Dist Birbhum W B,
Date ( Time ): 26/09/2017 ( 15:48:00 ) Suri,731101
bo_eps1@licindia.com
Receipt No : PR1002497700011718
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received With Thanks ` 18,015.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Krishnadas Mitra

Towards The Following :

Policy No Plan Inst. Premium No Of Inst Total Premium Tax* Branch

Name Term Mode Due From Late Fee Total Amt Next Due
Agency Code D.O.C. Sum Assured Due To CD Charges Reg. No.
(`) (`) (`)
469278916 165 18,015.00 1 18,015.00 0.00 461
Krishnadas 20 Yly 08/17 0.00 18,015.00 08/18
0170546E 28/08/2010 3,75,000 08/17 0.00

Page Total (`) 18,015.00 18,015.00 0.00

0.00 18,015.00
0.00
Grand Total (`) 18,015.00 18,015.00 0.00
0.00 18,015.00
0.00

EIGHTEEN THOUSAND FIFTEEN RUPEES AND ZERO PAISE ONLY

Krishnadas Mitra Consolidated Stamp Duty paid

C/O-Sourav Mitra AMuSh2016/2967/CR747/M1 w.e.f. 30/11/2016
Vill+Po-Chinpai, Ps-Sadaipur
Dt-Birbhum, Ps. Sadaipur

731104 Payment Acknowledgement generated through

Online Portal on 26-Sep-17 Time : 15:49:55.
Mobile: 8001624513
Email: kdasmitra@gmail.com

*Tax here indicates Goods and Service Tax (GST) from 01/07/2017 or Service Tax prior to 01/07/2017.

This receipt is electronically generated.

Har Pal Aapke Saath!

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