Collecting Branch : EPS1 Servicing Branch : LIC of India, New Delhi 11S

Goverdhan Bldg
Transaction No : 3484672
53-54,Nehru Place
Date ( Time ): 17/05/2019 ( 08:25:13 ) New Delhi,110019
bo_eps1@licindia.com
Receipt No : PR0348467200011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 10,554.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Subhash Kumar

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.
(`) (`) (`)
114799073 149 10,554.00 1 10,554.00 0.00 11S
Subhash Kumar 72 YLY 06/19 0.00 0.00 06/20
9806111S 15/06/2006 2,00,000 06/19 0.00 10,554.00

Page Total (`) 10,554.00 10,554.00 0.00

0.00 0.00
0.00 10,554.00
Grand Total (`) 10,554.00 10,554.00 0.00
0.00 0.00
0.00 10,554.00

GST borne by LIC of India ` 237.46

TEN THOUSAND FIVE HUNDRED FIFTY FOUR RUPEES AND ZERO PAISE ONLY

Subhash Kumar
Consolidated Stamp Duty Paid
H.No.F-2,/650,Shakti Khand-3,Indrapuram
Shipra Sun City CSD/328/2019/646/19 DTD.15/02/2019
Ghaziabad, U.P.

201012 Payment Acknowledgement generated through

Online Portal on 17-May-19 Time : 08:29:16.
Mobile: 9958140783
Email: seo.subhash@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!