Collecting Branch : EPS1 Servicing Branch : 174

E-mail : bo_eps1@licindia.com LIC of India, Bhatinda Branch Office

Phone : +91-022-1251 Bibiwala Road
Bathinda.
Transaction No. : PR0854181000011516
Bathinda
Date ( Time ): 21/10/2015 ( 20:28:34 ) 151006

RENEWAL PREMIUM RECEIPT

Received with thanks Rs. 18589.80 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Kamla Devi

Towards the following

Policy No Plan Inst. Prem(Rs) No Of Inst Total Premium Service Tax Branch
Name Term Mode Due Fr Late Fee Edu Cess Next Due
Agency Code D.O.C. Sum Assured Due To Total Amt
302250431 179 18,300.00 1 18,300.00 0.00 174
Kamla Devi 12 YLY 08/15 289.80 0.00 08/16
02924174 10/08/2012 2,00,000.00 08/15 18,589.80
Page Total (Rs) 18,300.00 18,300.00 0.00
289.80 0.00
18,589.80
Grand Total (Rs) 18,300.00 18,300.00 0.00
289.80 0.00
18,589.80

RUPEES EIGHTEEN THOUSAND FIVE HUNDRED EIGHTY-NINE AND EIGHTY PAISE ONLY

Kamla Devi A.Mu.Sh.2015/CR 242/M-1 Dated 15/05/2015

W/O Sh.Shri Krishan Kushwaha,
H.No.116,T-5,Ghtp Lehra Mohabbat
Dt.Bathinda
100000

This receipt is electronically generated.

Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi

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