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Collecting Branch : EPS1 Servicing Branch : LIC of India, Thiruvottiyur Br

NO.142-144
Transaction No : 12018813
T.H.Road,Tondiarpet Near RTO
Date ( Time ): 25/09/2018 ( 14:33:42 ) Chennai,600019
bo_eps1@licindia.com
Receipt No : PR1201881300011819
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 3,666.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : A Induja La
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.
(`) (`) (`)
717899484 102 3,666.00 1 3,666.00 0.00 71D
A Induja La 15 YLY 09/18 0.00 0.00 09/19
0044871D 22/09/2006 50,000.00 09/18 0.00 3,666.00

Page Total (`) 3,666.00 3,666.00 0.00


0.00 0.00
0.00 3,666.00
Grand Total (`) 3,666.00 3,666.00 0.00
0.00 0.00
0.00 3,666.00

GST borne by LIC of India ` 82.48

THREE THOUSAND SIX HUNDRED SIXTY SIX RUPEES AND ZERO PAISE ONLY

A Induja La
No. 1/225, Venkateswara Nagar,
Near Annai Anjugam Nagar,
61,Nandambakam, Kundrathur,Chennai

600069 Payment Acknowledgement generated through


Online Portal on 25-Sep-18 Time : 14:35:55.
Mobile: 9788664761
Email: maintenance@pecpl.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!

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