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

Near Aakashwani
Transaction No : 9770888
Civil Lines.,Chhattarpur M P
Date ( Time ): 09/08/2019 ( 12:01:03 ) Chhatarpur,471001
bo_eps1@licindia.com
Receipt No : PR0977088800011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 43,592.28 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Chouksey H
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.
(`) (`) (`)
209005411 815 42,247.00 1 42,247.00 505.39 372
Himanshu 25 YLY 06/19 334.50 505.39 06/20
03324371 28/06/2014 10,00,000 06/19 0.00 43,592.28 0

Page Total (`) 42,247.00 42,247.00 505.39

334.50 505.39
0.00 43,592.28
Grand Total (`) 42,247.00 42,247.00 505.39
334.50 505.39
0.00 43,592.28

FORTY THREE THOUSAND FIVE HUNDRED NINETY TWO RUPEES AND TWENTY EIGHT PAISE
ONLY

Chouksey H
Consolidated Stamp Duty Paid
S/O Sh. Ravindra Chaouksey
F-1, Civil Lines, Near Collector Bunglow CSD/328/2019/646/19 DTD.15/02/2019
Chhatarpur(Mp)

471001 Payment Acknowledgement generated through

Online Portal on 09-Aug-19 Time : 12:03:36.
Mobile: 8959177333
Email: himanshu.chouksey@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!