Collecting Branch : EPS1 Servicing Branch : LIC of India, Br Office, P B No
P B No. 14 Kota Vari Street
Transaction No : 20235598 Railpet.,Repalle (Ap) Date ( Time ): 19/02/2018 ( 16:42:17 ) Repalle,522265 bo_eps1@licindia.com Receipt No : PR2023559800011718 HelpDesk: +91-022-1251
RENEWAL PREMIUM RECEIPT
Received with thanks ` 1,015.00 through Payment Gateway over the Internet from:
Smt./Ms./Shri : Ibrahim Khan
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. (`) (`) (`) 676377070 91 1,015.00 1 1,015.00 0.00 67C Ibrahim Khan 18 HLY 02/18 0.00 0.00 08/18 0063467C 19/08/2009 35,000.00 02/18 0.00 1,015.00
Page Total (`) 1,015.00 1,015.00 0.00
0.00 0.00 0.00 1,015.00 Grand Total (`) 1,015.00 1,015.00 0.00 0.00 0.00 0.00 1,015.00
GST borne by LIC of India ` 22.84
ONE THOUSAND FIFTEEN RUPEES AND ZERO PAISE ONLY
Ibrahim Khan S/O Subhani Khan Late 5-9 --3,25th Ward,Near Nup School, Repalle Po,Md Guntur Dt
522265 Payment Acknowledgement generated through
Online Portal on 24-Mar-19 Time : 10:06:58. Mobile: 8374908485 Email: ibrahimsimplekhan@gmail.com
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