Collecting Branch : EPS1 Servicing Branch : LIC of India, Rock Fort Branch

19/20 Bharatiyar Road P B No-488

Transaction No : 31249480
Tiruchirapalli.,Tamilnadu
Date ( Time ): 29/03/2020 ( 12:38:58 ) Trichy,620008
bo_eps1@licindia.com
Receipt No : PR3124948000011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 1,32,409.66 through Payment Gateway over the Internet from:

Smt./Ms./Shri : B . Chandrakanth
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.
(`) (`) (`)
305146695 836 1,29,496.00 1 1,29,496.00 1,456.83 665
B. 16 YLY 03/20 0.00 1,456.83 03/21
02595665 20/03/2018 03/20 0.00 1,32,409.66 33AAACL0582H1ZT
15,00,000

Page Total (`) 1,29,496.00 1,29,496.00 1,456.83

0.00 1,456.83
0.00 1,32,409.66
Grand Total (`) 1,29,496.00 1,29,496.00 1,456.83
0.00 1,456.83
0.00 1,32,409.66

ONE LAKH THIRTY TWO THOUSAND FOUR HUNDRED NINE RUPEES AND SIXTY SIX PAISE ONLY

B . Chandrakanth
Consolidated Stamp Duty Paid
S/O M Balasubramanian
No 5 Srinagar Trunk Road CSD/323/2020/802/2020 DTD.20/02/2020
Thiruvanaikovil Trichy

620005 Payment Acknowledgement generated through

Online Portal on 29-Mar-20 Time : 12:40:12.
Mobile: 9443131373
Email: chandrakanth.bala@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!