Collecting Branch : EPS1 Servicing Branch : LIC of India, City Br II, P B No-

Nallamachu Kondiah Building

Transaction No : 8970651
Karimnagar.,Andhra Pradesh
Date ( Time ): 14/08/2018 ( 08:18:36 ) Karimnagar ,505001
bo_eps1@licindia.com
Receipt No : PR0897065100011819
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 1,824.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Arram Laxmi

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.
(`) (`) (`)
684117287 14 1,824.00 1 1,824.00 0.00 68M
Arram Laxmi 16 HLY 07/18 0.00 0.00 01/19
0077168M 28/07/2004 50,000.00 07/18 0.00 1,824.00

Page Total (`) 1,824.00 1,824.00 0.00

0.00 0.00
0.00 1,824.00
Grand Total (`) 1,824.00 1,824.00 0.00
0.00 0.00
0.00 1,824.00

GST borne by LIC of India ` 41.04

ONE THOUSAND EIGHT HUNDRED TWENTY FOUR RUPEES AND ZERO PAISE ONLY

Arram Laxmi
W/O A.Bhoomaiah
Gangadhara, Po Vil, X Road
Mdl:Gangadhara, Dt:Karimnagar

505445 Payment Acknowledgement generated through

Online Portal on 14-Aug-18 Time : 08:19:33.
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Email: laxman318362@gmail.com

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Har Pal Aapke Saath!