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

Rambagh.
Transaction No : 16633270
Mirzapur,
Date ( Time ): 29/10/2019 ( 21:04:29 ) Mirzapur,231001
bo_eps1@licindia.com
Receipt No : PR1663327000011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 2,614.97 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Smt.Sangeeta
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.
(`) (`) (`)
283483166 93 2,567.00 1 2,567.00 3.66 287
Smt.Sangeeta 25 YLY 09/19 40.65 3.66 09/20
03834287 15/09/2003 50,000.00 09/19 0.00 2,614.97 0

Page Total (`) 2,567.00 2,567.00 3.66

40.65 3.66
0.00 2,614.97
Grand Total (`) 2,567.00 2,567.00 3.66
40.65 3.66
0.00 2,614.97

GST borne by LIC of India ` 57.76

TWO THOUSAND SIX HUNDRED FOURTEEN RUPEES AND NINETY SEVEN PAISE ONLY

Smt.Sangeeta
W/O.Sri Ram Prakash Mall
Vill. Post.Sidha Ahilaspur,
Distt.Mau

100000 Payment Acknowledgement generated through

Online Portal on 29-Oct-19 Time : 21:06:19.
Mobile: 9307938901
Email: ramprakashmall56@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!