Collecting Center : A001 Branch Code : 25H

LIC of India, Ghaziabad Branch II 25H

Transaction No. : 10738395 408/2,Model Town,
G.T.Road,
Date ( Time ): 03/03/2019 ( 13:16:04 ) Ghaziabad, 201001
email: bo_25H@licindia.com
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks Rs. 3,235.00 from policyholder Shri/Smt.Manuj Gupta

towards the following policy/ies

Policy No Plan Inst. Prem(Rs) No Of Inst Total Premium CGST Branch

Name Term Mode Due Fr Late Fee SGST/UTGST Next Due
Agency D.O.C. Sum Assured Due To CD Chgs Total Amt Reg. No.
Code
253648905 149 3,235.00 1 3,235.00 0.00 25H
Gupta 81 YLY 03/19 0.00 0.00 03/20
0185825H 26/03/2005 1,00,000.00 03/19 0.00 3,235.00
Page Total (Rs) 3,235.00 3,235.00 0.00
0.00 0.00
0.00 3,235.00
Grand Total (Rs) 3,235.00 3,235.00 0.00
0.00 0.00
0.00 3,235.00

RUPEES THREE THOUSAND TWO HUNDRED THIRTY-FIVE ONLY

Paid by Cash/Card :0.00
Paid by Cheque :3,235.00
Cheque No :631196
Cheque Date :01/03/2019

Manuj Gupta Consolidated Stamp Duty Paid

S/Osh Rakesh Gupta
38,Double Story,Welcome Seelampur
Phase Ii,Delhi For Life Insurance Corporation of India,
110053. Sh.Hari Shanker Tiwari(55355111)
Mobile:
Email:

**GST borne by LIC of India is Rs 72.78

This receipt is subject to realisation of cheque amount.

Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi