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

150
Transaction No : 21947410
Luz Church Road,Mylapore
Date ( Time ): 28/01/2019 ( 15:03:35 ) Chennai,600004
bo_eps1@licindia.com
Receipt No : PR2194741000011819
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 8,708.64 through Payment Gateway over the Internet from:

Smt./Ms./Shri : M.Diwakar
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.
(`) (`) (`)
707490033 833 8,517.00 1 8,517.00 95.82 70R
M.Diwakar 18 QLY 12/18 0.00 95.82 03/19
0242570R 28/03/2017 5,00,000 12/18 0.00 8,708.64

Page Total (`) 8,517.00 8,517.00 95.82

0.00 95.82
0.00 8,708.64
Grand Total (`) 8,517.00 8,517.00 95.82
0.00 95.82
0.00 8,708.64

EIGHT THOUSAND SEVEN HUNDRED EIGHT RUPEES AND SIXTY FOUR PAISE ONLY

M.Diwakar
Consolidated Stamp Duty Paid
61/30, Apparsamy Koil Street,
Mylapore, CSD/64/2018/2366/18 dtd. 26/06/2018
Chennai

600004 Payment Acknowledgement generated through

Online Portal on 28-Jan-19 Time : 15:06:42.
Mobile: 9952097996
Email: diwakar1461@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!