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Collecting Branch : EPS1 Servicing Branch : LIC of India, Muzaffarpur

Near Devi Mandir


Transaction No : 14147234
Umashankar Pd Marg ,Muzaffarpur.
Date ( Time ): 29/09/2019 ( 09:14:28 ) Muzaffarpur,842062
bo_eps1@licindia.com
Receipt No : PR1414723400011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 1,210.25 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Sanjay 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.
(`) (`) (`)
535350188 150 1,188.00 1 1,188.00 1.70 515
Sanjay Kumar 30 YLY 07/19 18.85 1.7 07/20
00095515 28/07/2005 1,00,000 07/19 0.00 1,210.25 0

Page Total (`) 1,188.00 1,188.00 1.70


18.85 1.70
0.00 1,210.25
Grand Total (`) 1,188.00 1,188.00 1.70
18.85 1.70
0.00 1,210.25

GST borne by LIC of India ` 26.74


ONE THOUSAND TWO HUNDRED TEN RUPEES AND TWENTY FIVE PAISE ONLY

Sanjay Kumar
C/O-Baiju Sah
At-Majhaulia,Po-Khabra
Dt-Muzaffarpur

100000 Payment Acknowledgement generated through


Online Portal on 29-Sep-19 Time : 09:19:10.
Mobile: 9304768186
Email: shreelaxmielectricalsmfp@gmail.co

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!

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