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

At & Po Bhadrak Main Road

Transaction No : 19971267
Dist-Bhadrak.,Orissa
Date ( Time ): 08/12/2019 ( 17:01:14 ) Bhadrak,756100
bo_eps1@licindia.com
Receipt No : PR1997126700011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 16,811.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Ganesh Prasad Panda

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.
(`) (`) (`)
586555097 149 16,811.00 1 16,811.00 0.00 593
Ganesh Prasad 62 YLY 11/19 0.00 0.0 11/20
00927593 17/11/2006 11/19 0.00 16,811.00 21AAACL0582H1ZY
3,00,000

Page Total (`) 16,811.00 16,811.00 0.00

0.00 0.00
0.00 16,811.00
Grand Total (`) 16,811.00 16,811.00 0.00
0.00 0.00
0.00 16,811.00

GST borne by LIC of India ` 378.24

SIXTEEN THOUSAND EIGHT HUNDRED ELEVEN RUPEES AND ZERO PAISE ONLY

Ganesh Prasad Panda

Consolidated Stamp Duty Paid
At-Rumitra
Po/Via-Balikhand CSD/328/2019/646/19 DTD.15/02/2019
Dist-Balasore

756166 Payment Acknowledgement generated through

Online Portal on 08-Dec-19 Time : 17:05:19.
Mobile: 8763844029
Email: ganesh_prasad.panda@sbi.co.in

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!