Collecting Branch : EPS1 Servicing Branch : LIC of India, Bellary Br Office

Post Box No 29 L I C Buildings

Transaction No : 7639510
Station Road Bellary.,Karnataka
Date ( Time ): 26/07/2018 ( 18:17:53 ) Bellary-I,583101
bo_eps1@licindia.com
Receipt No : PR0763951000011819
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 67,528.96 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Nagana Gowda.J

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.
(`) (`) (`)
665952287 815 66,043.00 1 66,043.00 742.98 628
Nagana 20 YLY 07/18 0.00 742.98 07/19
03590628 12/07/2014 12,00,000 07/18 0.00 67,528.96

Page Total (`) 66,043.00 66,043.00 742.98

0.00 742.98
0.00 67,528.96
Grand Total (`) 66,043.00 66,043.00 742.98
0.00 742.98
0.00 67,528.96

SIXTY SEVEN THOUSAND FIVE HUNDRED TWENTY EIGHT RUPEES AND NINETY SIX PAISE ONLY

Nagana Gowda.J
Consolidated Stamp Duty Paid
S/O Bhaktavatsala.J, No-325
Bellary Main Road, Konchigeri;Po CSD/64/2018/2366/18 dtd. 26/06/2018
Siruguppa;Tq,Bellary;Dt

583101 Payment Acknowledgement generated through

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Email: goudmech@gmail.com

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