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

16/112 Bhargava Estate.

Transaction No : 25129994
M G Marg Kanpur,
Date ( Time ): 27/10/2020 ( 17:10:52 ) Kanpur,0
Email: bo_eps1@licindia.com
Receipt No : PR2512999400012021
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 21,833.44 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Prahlad Ray Shyamani

towards the following :

Policy No Plan / Term Inst. Premium No Of Inst Total Premium CGST Branch
Name D.O.C. Mode Due From Late Fee SGST/UTGST Next Due
Revival Sum Assured Due To CD Charges Total Amt Reg. No.
Agency Code
(Yes/No) (`) (`) (`)
238310877 814 / 16 21,353.00 1 21,353.00 240.22 232
Prahlad Ray 28/10/2015 YLY 10/20 0.00 240.22 10/21
No 10/20 0.00 21,833.44 09AAACL0582HFZ6
07483232 3,00,000

Page Total (`) 21,353.00 21,353.00 240.22

0.00 240.22
0.00 21,833.44
Grand Total (`) 21,353.00 21,353.00 240.22
0.00 240.22
0.00 21,833.44

TWENTY ONE THOUSAND EIGHT HUNDRED THIRTY THREE RUPEES AND FORTY FOUR PAISE
ONLY

Prahlad Ray Shyamani

Consolidated Stamp Duty Paid
M.I.G.79,Barra-3near Shastri Chauk
Kanpur Nagar CSD/113/2020/1936 DTD. 18.09.2020
U,.P

208027 Payment Acknowledgement generated through

Online Portal on 27-Oct-20 Time : 17:12:26.
Mobile: 94******65
Email: pr********33@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!