Collecting Branch : EPS1 Servicing Branch : LIC of India, Hyderabad City

No-5/8-190 1st Floor Paigah Complex

Transaction No : 15686583
Hotel Yatrik Compound Nampally.,
Date ( Time ): 03/02/2017 ( 15:51:18 ) Hyderabad,500001
bo_eps1@licindia.com
Receipt No : PR1568658300011617
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 26,555.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Archana Reddyreddy

towards the following :

Policy No Plan Inst. Premium No Of Inst Total Premium CGST Branch

Name Term Mode Due From Late Fee SGST/UTGST Next Due
Agency Code D.O.C. Sum Assured Due To CD Charges Total Amt Reg. No.
(`) (`) (`)
645261792 149 26,555.00 1 26,555.00 0.00 643
Reddyreddy 76 YLY 02/17 0.00 0.00 02/18
03159643 28/02/2007 5,00,000 02/17 0.00 26,555.00

Page Total (`) 26,555.00 26,555.00 0.00

0.00 0.00
0.00 26,555.00
Grand Total (`) 26,555.00 26,555.00 0.00
0.00 0.00
0.00 26,555.00

TWENTY SIX THOUSAND FIVE HUNDRED FIFTY FIVE RUPEES AND ZERO PAISE ONLY

Archana Reddyreddy
#V 3-4-310 172, Flat 504
Siddartha Santhi Niketan Apts,
Kachiguda, Hyderabad

500027 Payment Acknowledgement generated through

Online Portal on 21-Jan-18 Time : 21:14:19.
Mobile: 919573666751
Email: archanareddy19@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!