Collecting Branch : EPS1 Servicing Branch : LIC of India, Panipat II Br P B

65-B Narain Singh Park Nr Seema

Transaction No : 6527015
Panipat,Dt Karnal
Date ( Time ): 28/06/2019 ( 10:56:08 ) Panipat,132103
bo_eps1@licindia.com
Receipt No : PR0652701500011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 11,792.50 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Dinesh Kumar

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.
(`) (`) (`)
178316295 815 11,533.00 1 11,533.00 129.75 17A
Dinesh Kumar 21 YLY 06/19 0.00 129.75 06/20
0094917A 20/06/2014 2,00,000 06/19 0.00 11,792.50

Page Total (`) 11,533.00 11,533.00 129.75

0.00 129.75
0.00 11,792.50
Grand Total (`) 11,533.00 11,533.00 129.75
0.00 129.75
0.00 11,792.50

ELEVEN THOUSAND SEVEN HUNDRED NINETY TWO RUPEES AND FIFTY PAISE ONLY

Dinesh Kumar
Consolidated Stamp Duty Paid
S/O Sh. Raghbir Singh
H.N.507/1,Shiv Colony CSD/328/2019/646/19 DTD.15/02/2019
Safidon,Jind

126112 Payment Acknowledgement generated through

Online Portal on 28-Jun-19 Time : 10:57:52.
Mobile: 8295500470
Email: dineshsafidon@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!