Collecting Branch : EPS1 Servicing Branch : LIC of India, Kendrapara

At/Post-Kendrapara.
Transaction No : 25415698
Dist-Kendrapara (Orissa),
Date ( Time ): 05/03/2019 ( 11:20:04 ) Kendrapara,754211
bo_eps1@licindia.com
Receipt No : PR2541569800011819
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 4,746.29 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Truptimayee Nayak

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.
(`) (`) (`)
559538499 841 2,249.00 2 4,498.00 61.82 504
Truptimayee 16 QLY 10/18 124.65 61.82 04/19
01382504 16/01/2017 1,00,000 01/19 0.00 4,746.29

Page Total (`) 2,249.00 4,498.00 61.82

124.65 61.82
0.00 4,746.29
Grand Total (`) 2,249.00 4,498.00 61.82
124.65 61.82
0.00 4,746.29

FOUR THOUSAND SEVEN HUNDRED FORTY SIX RUPEES AND TWENTY NINE PAISE ONLY

Truptimayee Nayak
C/O-Pramod Kumar Nayak
At-Odang Po-Akhuadakhini
Dist-Kendrapara

754228 Payment Acknowledgement generated through

Online Portal on 05-Mar-19 Time : 11:23:09.
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