Collecting Branch : EPS1 Servicing Branch : LIC of India, Chinchwad Br

II Floor, Gheewala Complex,

Transaction No : 23076536
Opp. Ramkrishna More
Date ( Time ): 08/02/2019 ( 13:05:43 ) Chinchwad,411033
bo_eps1@licindia.com
Receipt No : PR2307653600011819
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 4,647.73 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Valappil D K
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.
(`) (`) (`)
993765662 815 2,242.00 2 4,484.00 55.24 95B
Devesh 25 QLY 10/18 53.25 55.24 04/19
4232295B 28/01/2014 2,00,000 01/19 0.00 4,647.73

Page Total (`) 2,242.00 4,484.00 55.24

53.25 55.24
0.00 4,647.73
Grand Total (`) 2,242.00 4,484.00 55.24
53.25 55.24
0.00 4,647.73

FOUR THOUSAND SIX HUNDRED FORTY SEVEN RUPEES AND SEVENTY THREE PAISE ONLY

Valappil D K

Payment Acknowledgement generated through

Online Portal on 08-Feb-19 Time : 13:06:49.
Mobile: 8139918333
Email: deveshready@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!