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

Post Box No 9 19-99 M P Rd.

Transaction No : 21576861
Hindupur A P,
Date ( Time ): 23/01/2019 ( 21:01:39 ) Hindupur,515201
bo_eps1@licindia.com
Receipt No : PR2157686100011819
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 5,085.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Sri. Rn. R-Nagarathnamma

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.
(`) (`) (`)
162795870 169 5,085.00 1 5,085.00 0.00 657
Sri. Rn. R- 15 HLY 12/18 0.00 0.00 06/19
0033016Y 28/12/2004 1,35,000 12/18 0.00 5,085.00

Page Total (`) 5,085.00 5,085.00 0.00

0.00 0.00
0.00 5,085.00
Grand Total (`) 5,085.00 5,085.00 0.00
0.00 0.00
0.00 5,085.00

GST borne by LIC of India ` 114.42

FIVE THOUSAND EIGHTY FIVE RUPEES AND ZERO PAISE ONLY

Sri. Rn. R-Nagarathnamma

Consolidated Stamp Duty Paid
S/O Sh.R.Pedda Reddy
Type-Iii/17,Thapar Institute Campus CSD/64/2018/2366/18 dtd. 26/06/2018
Patiala

147001 Payment Acknowledgement generated through

Online Portal on 23-Jan-19 Time : 21:05:27.
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Email: siva19899@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!