Collecting Branch : EPS1 Servicing Branch : LIC of India,

Narasampet Branch Office

Transaction No : 21703201
Narasampet.,[A P]
Date ( Time ): 25/01/2019 ( 12:53:27 ) Narasampet,0
bo_eps1@licindia.com
Receipt No : PR2170320100021819
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 71,003.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Pramodkumar D
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.
(`) (`) (`)
689240933 179 17,795.00 1 17,795.00 0.00 68N
Dharbhashayan 20 YLY 01/19 0.00 0.00 01/20
0035968N 14/01/2012 5,00,000 01/19 0.00 17,795.00

689240927 149 53,208.00 1 53,208.00 0.00 68N

Dharbhashayan 73 YLY 01/19 0.00 0.00 01/20
0035968N 14/01/2012 10,00,000 01/19 0.00 53,208.00

Page Total (`) 71,003.00 71,003.00 0.00

0.00 0.00
0.00 71,003.00
Grand Total (`) 71,003.00 71,003.00 0.00
0.00 0.00
0.00 71,003.00

GST borne by LIC of India ` 1,597.56

SEVENTY ONE THOUSAND THREE RUPEES AND ZERO PAISE ONLY

Pramodkumar D
Consolidated Stamp Duty Paid
CSD/64/2018/2366/18 dtd. 26/06/2018

Payment Acknowledgement generated through

Online Portal on 25-Jan-19 Time : 12:54:54.
Mobile: 9989234232
Email: pramod.cbit@gmail.com
This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!