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

Sheth H H Batrisi Hall Near R T O

Transaction No : 15160684
Near Subhash Bridge Ashram
Date ( Time ): 10/10/2019 ( 15:35:30 ) Sabarmati,380005
bo_eps1@licindia.com
Receipt No : PR1516068400011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 9,255.28 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Thanth Ketanbhai Parshotambhai

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.
(`) (`) (`)
849848577 815 2,921.00 3 8,763.00 148.94 84D
Thanth 30 MLY 08/19 69.40 148.94 11/19
0117184D 18/09/2018 10,00,000 10/19 125.00 9,255.28 0

Page Total (`) 2,921.00 8,763.00 148.94

69.40 148.94
125.00 9,255.28
Grand Total (`) 2,921.00 8,763.00 148.94
69.40 148.94
125.00 9,255.28

NINE THOUSAND TWO HUNDRED FIFTY FIVE RUPEES AND TWENTY EIGHT PAISE ONLY

Thanth Ketanbhai Parshotambhai

Consolidated Stamp Duty Paid
659-Jin Vistar
S.P.O-Tansa , At-Tansa CSD/328/2019/646/19 DTD.15/02/2019
Ta-Dhodha, Dist-Bhavnagar

364120 Payment Acknowledgement generated through

Online Portal on 10-Oct-19 Time : 15:38:13.
Mobile: 9924953727
Email: ketanthanth0@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!