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.