Collecting Branch : EPS1 Servicing Branch : LIC of India, Tambaram Br

17 Upstairs
Transaction No : 22774102
Shanmugam Road ,West Tambaram
Date ( Time ): 05/02/2019 ( 20:39:12 ) Tambaram,600045
bo_eps1@licindia.com
Receipt No : PR2277410200011819
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 1,024.16 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Indira Karthikeyan

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.
(`) (`) (`)
717460120 149 505.00 2 1,010.00 1.08 71A
Smt K.Indira, 64 MLY 12/18 12.00 1.08 02/19
0101470U 12/09/2005 1,00,000 01/19 0.00 1,024.16

Page Total (`) 505.00 1,010.00 1.08

12.00 1.08
0.00 1,024.16
Grand Total (`) 505.00 1,010.00 1.08
12.00 1.08
0.00 1,024.16

GST borne by LIC of India ` 22.72

ONE THOUSAND TWENTY FOUR RUPEES AND SIXTEEN PAISE ONLY

Indira Karthikeyan
No.2d,Sundaresan 1st Cross,
St, 1st Floor,Rajaji Nagar,
Pallavaram,Chennai-600 043.

600043 Payment Acknowledgement generated through

Online Portal on 05-Feb-19 Time : 20:41:06.
Mobile: 9941286450
Email: asvignesh1932000@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!