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

HIMALAYA COMPLEX,OPP.OLD
Transaction No : 25454459
MIRA BHAYANDER
Date ( Time ): 05/03/2019 ( 15:16:56 ) Thane,0
bo_eps1@licindia.com
Receipt No : PR2545445900011819
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 6,868.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Mr Arun Prakash K Mishra

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.
(`) (`) (`)
923260723 14 6,868.00 1 6,868.00 0.00 92L
Mr Arun Prakash 15 YLY 02/19 0.00 0.00 02/20
0034992L 15/02/2005 1,00,000 02/19 0.00 6,868.00

Page Total (`) 6,868.00 6,868.00 0.00

0.00 0.00
0.00 6,868.00
Grand Total (`) 6,868.00 6,868.00 0.00
0.00 0.00
0.00 6,868.00

GST borne by LIC of India ` 154.54

SIX THOUSAND EIGHT HUNDRED SIXTY EIGHT RUPEES AND ZERO PAISE ONLY

Mr Arun Prakash K Mishra

Consolidated Stamp Duty Paid
C/O Sri Sudhakar Sadashiv Shukla Om
Charanam B (G-2) A Wing Shirdi Naga CSD/64/2018/2366/18 dtd. 26/06/2018
Navghar Phatak Rd Bhayander East.

401105 Payment Acknowledgement generated through

Online Portal on 05-Mar-19 Time : 15:21:42.
Mobile: 9833223774
Email: arunm1433@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!