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

Polt No. 104 Sec. 44


Transaction No : 6412717
Gurgaon ,Haryana.
Date ( Time ): 09/07/2018 ( 08:08:20 ) Gurgaon,122001
bo_eps1@licindia.com
Receipt No : PR0641271700011819
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 3,065.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Rani Antima A


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.
(`) (`) (`)
331497096 102 3,065.00 1 3,065.00 0.00 122
Rani Antima A 16 HLY 06/18 0.00 0.00 12/18
03471122 28/12/2005 1,00,000 06/18 0.00 3,065.00

Page Total (`) 3,065.00 3,065.00 0.00


0.00 0.00
0.00 3,065.00
Grand Total (`) 3,065.00 3,065.00 0.00
0.00 0.00
0.00 3,065.00

GST borne by LIC of India ` 68.96

THREE THOUSAND SIXTY FIVE RUPEES AND ZERO PAISE ONLY

Rani Antima A
Sh.Ajit Singh P
Vpo.Jaurasi.Teh.Tauru
Distt.Gurgaon Hry

122105 Payment Acknowledgement generated through


Online Portal on 09-Jul-18 Time : 08:10:27.
Mobile: 9992855241
Email: ajit_singh16167@yahoo.co.in

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!

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