Collecting Branch : EPS1 Servicing Branch : LIC of India, 12f Br Office Delhi

Tirupati Balaji Bldg

Transaction No : 15150887
13/14 D D A Shopping Centre.,Pocket
Date ( Time ): 09/11/2018 ( 11:45:28 ) New Delhi,110091
bo_eps1@licindia.com
Receipt No : PR1515088700011819
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 5,753.78 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Ashok Kumar

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.
(`) (`) (`)
128149641 814 5,506.00 1 5,506.00 123.89 12F
Ashok Kumar 15 HLY 11/18 0.00 123.89 05/19
0230112F 18/05/2018 1,50,000 11/18 0.00 5,753.78

Page Total (`) 5,506.00 5,506.00 123.89

0.00 123.89
0.00 5,753.78
Grand Total (`) 5,506.00 5,506.00 123.89
0.00 123.89
0.00 5,753.78

FIVE THOUSAND SEVEN HUNDRED FIFTY THREE RUPEES AND SEVENTY EIGHT PAISE ONLY

Ashok Kumar
Consolidated Stamp Duty Paid
23/176 Trilok Puri
Delhi CSD/64/2018/2366/18 dtd. 26/06/2018

110091 Payment Acknowledgement generated through

Online Portal on 09-Nov-18 Time : 11:47:20.
Mobile: 9873617058
Email: palashokkumar76@gmail.com

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Har Pal Aapke Saath!