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

P O Dhenkanal.
Transaction No : 14615305
Dt Dhenkanal,
Date ( Time ): 03/10/2019 ( 12:58:08 ) Dhenkanal,759001
bo_eps1@licindia.com
Receipt No : PR1461530500011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 12,898.63 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Madhusmita Mishra

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.
(`) (`) (`)
588640690 178 12,434.00 1 12,434.00 35.44 582
Madhusmita 75 HLY 06/19 393.75 35.44 12/19
02056582 15/12/2009 5,00,000 06/19 0.00 12,898.63 0

Page Total (`) 12,434.00 12,434.00 35.44

393.75 35.44
0.00 12,898.63
Grand Total (`) 12,434.00 12,434.00 35.44
393.75 35.44
0.00 12,898.63

GST borne by LIC of India ` 279.76

TWELVE THOUSAND EIGHT HUNDRED NINETY EIGHT RUPEES AND SIXTY THREE PAISE ONLY

Madhusmita Mishra
Consolidated Stamp Duty Paid
C/O-Prasanta Kumar Mishra
At-Nalambarpur,Po-Siminai CSD/328/2019/646/19 DTD.15/02/2019
Dist-Dhenkanal

759025 Payment Acknowledgement generated through

Online Portal on 03-Oct-19 Time : 13:02:09.
Mobile: 9137719256
Email: nanda.retail@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!