Collecting Branch : EPS1 Servicing Branch : LIC of India, Ambala City

Jeevan Sewa P B No 6
Transaction No : 18763189
New Municipal Shopping
Date ( Time ): 25/11/2019 ( 19:58:15 ) Ambala City,134003
bo_eps1@licindia.com
Receipt No : PR1876318900011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 3,104.93 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Nikhil Kumar Jha

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.
(`) (`) (`)
119350789 815 2,919.00 1 2,919.00 69.84 331
Nikhil Kumar 20 HLY 09/19 46.25 69.84 03/20
02590331 18/03/2019 1,00,000 09/19 0.00 3,104.93 0

Page Total (`) 2,919.00 2,919.00 69.84

46.25 69.84
0.00 3,104.93
Grand Total (`) 2,919.00 2,919.00 69.84
46.25 69.84
0.00 3,104.93

THREE THOUSAND ONE HUNDRED FOUR RUPEES AND NINETY THREE PAISE ONLY

Nikhil Kumar Jha

S/O Sh Pawan Kumar Jha
1920, Housing Board Colony
Sec-10 Ambala City

134003 Payment Acknowledgement generated through

Online Portal on 25-Nov-19 Time : 20:01:22.
Mobile: 9034359815
Email: nikhiljha5555@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!