Collecting Branch : EPS1 Servicing Branch : LIC of India, Chennai City Br

No-3 United India Colony

Transaction No : 18999330
4th Main Road ,Kodambakkam
Date ( Time ): 03/02/2018 ( 14:07:09 ) Chennai ,600024
bo_eps1@licindia.com
Receipt No : PR1899933000011718
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 16,987.52 through Payment Gateway over the Internet from:

Smt./Ms./Shri : M.Siva Anand S/O,S.Murugesan

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.
(`) (`) (`)
707620455 815 16,256.00 1 16,256.00 365.76 71L
M.Siva Anand 25 QLY 02/18 0.00 365.76 05/18
0300271L 08/11/2017 15,00,000 02/18 0.00 16,987.52

Page Total (`) 16,256.00 16,256.00 365.76

0.00 365.76
0.00 16,987.52
Grand Total (`) 16,256.00 16,256.00 365.76
0.00 365.76
0.00 16,987.52

SIXTEEN THOUSAND NINE HUNDRED EIGHTY SEVEN RUPEES AND FIFTY TWO PAISE ONLY

M.Siva Anand S/O,S.Murugesan Consolidated Stamp Duty Paid

No:400-A,Mariamman Koil St, AMuSh2016/2967/CR747/M1 w.e.f. 30/11/2016
Srivalliputtur
Virudhunagar(Dt)

626125 Payment Acknowledgement generated through

Online Portal on 03-Feb-18 Time : 14:09:55.
Mobile: 9994391870
Email: sivsivawillbe@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!