Collecting Branch : EPS1 Servicing Branch : LIC of India, Jajpur Town

At & P O Jajpur.
Transaction No : 4154909
Dt Cuttack Orissa,
Date ( Time ): 27/05/2019 ( 19:03:33 ) Jajpur Town,755001
bo_eps1@licindia.com
Receipt No : PR0415490900011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 11,860.53 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Kunmun Sahoo Ganesh Prsad Das

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.
(`) (`) (`)
599417632 89 11,643.00 1 11,643.00 16.59 58D
Kunmun Sahoo 21 YLY 03/19 184.35 16.59 03/20
0103158D 28/03/2013 2,05,000 03/19 0.00 11,860.53

Page Total (`) 11,643.00 11,643.00 16.59

184.35 16.59
0.00 11,860.53
Grand Total (`) 11,643.00 11,643.00 16.59
184.35 16.59
0.00 11,860.53

GST borne by LIC of India ` 261.96

ELEVEN THOUSAND EIGHT HUNDRED SIXTY RUPEES AND FIFTY THREE PAISE ONLY

Kunmun Sahoo Ganesh Prsad Das

Consolidated Stamp Duty Paid
W/O-Ganesh Prasad Das
At-Naharapur(Redcross Chhak) CSD/328/2019/646/19 DTD.15/02/2019
Po/Dt-Jajpur, Odisha

755001 Payment Acknowledgement generated through

Online Portal on 27-May-19 Time : 19:12:29.
Mobile: 9861213865
Email: k.sahoo118@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!