Collecting Branch : EPS1 Servicing Branch : LIC of India, Br Office I

Post Box No 8 Almirah House

Transaction No : 20853306
2 Police Line Rd.,Bhagalpur
Date ( Time ): 18/12/2019 ( 14:42:40 ) Bhagalpur,812001
bo_eps1@licindia.com
Receipt No : PR2085330600011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 53,969.60 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Koppala Chandra Sekhar

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.
(`) (`) (`)
597687708 815 52,782.00 1 52,782.00 593.80 523
Koppala 21 YLY 12/19 0.00 593.8 12/20
06380523 28/12/2017 12/19 0.00 53,969.60 10AAACL0582H2Z0
10,00,000

Page Total (`) 52,782.00 52,782.00 593.80

0.00 593.80
0.00 53,969.60
Grand Total (`) 52,782.00 52,782.00 593.80
0.00 593.80
0.00 53,969.60

FIFTY THREE THOUSAND NINE HUNDRED SIXTY NINE RUPEES AND SIXTY PAISE ONLY

Koppala Chandra Sekhar

Consolidated Stamp Duty Paid
S/O-Kalappa Koppala
16-706 Sarojini Devi Street Sriram CSD/328/2019/646/19 DTD.15/02/2019
Nagar Colony Srikalahasti

517644 Payment Acknowledgement generated through

Online Portal on 18-Dec-19 Time : 14:44:14.
Mobile: 9844284979
Email: ckoppala408@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!