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Collecting Branch : EPS1

E-mail : bo_eps1@licindia.com
Phone : +91-022-1251

Servicing Branch : 731


LIC of India, Chennai (CBO-X)
INDIAN MUTUAL BUILDING
OLD NO 45 NEW NO 56
ANNASALAI
Chennai
Tamil Nadu 600002

Transaction No. : PR0891639600011516


Date ( Time ): 31/10/2015 ( 10:20:48 )

RENEWAL PREMIUM RECEIPT


Received with thanks Rs. 1619.70 through Payment Gateway over the Internet from:
Smt./Ms./Shri : S.Sasikumar
Towards the following
Policy No
Name
Agency Code
714173823

Plan
Term
D.O.C.
174
Sasikumar S
20
01960731
13/03/2006
Page Total (Rs)

Grand Total (Rs)

Inst. Prem(Rs)
Mode
Sum Assured
1,607.00
MLY
5,00,000.00
1,607.00

1,607.00

No Of Inst
Due Fr
Due To
1
10/15
10/15

Total Premium
Late Fee
1,607.00
12.70
1,607.00
12.70
1,607.00
12.70

Service Tax
Edu Cess
Total Amt
0.00
0.00
1,619.70
0.00
0.00
1,619.70
0.00
0.00
1,619.70

Branch
Next Due
731
11/15

RUPEES ONE THOUSAND SIX HUNDRED NINETEEN AND SEVENTY PAISE ONLY
S.Sasikumar
No:213, Ist Street, Prakash Nagar,
Ponniammen Medu,
Chennai.
600110
This receipt is electronically generated.

Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi


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