Collecting Branch : EPS1 Servicing Branch : 226

E-mail : bo_eps1@licindia.com LIC of India,Lucknow City Branch

Phone : +91-022-1251 3rd Floor Halwasiya Market
Hazaratganj.
Transaction No. : PR0030489700011213 Lucknow
Lucknow City
Date ( Time ): 12/04/2012 ( 13:40:24 ) 226001

RENEWAL PREMIUM RECEIPT

Received with thanks Rs. 5088.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Sri Vijay Kumar Gupta

Towards the following

Policy No Plan Inst. Prem(Rs) No Of Inst Total Premium Branch

Name Term Mode Due Fr Late Fee Next Due
Agency Code D.O.C. Sum Assured Due To Total Amt
280243915 93 5,088.00 1 5,088.00 226
Gupta Vk 25 YLY 03/12 0.00 03/13
00693289 21/03/1990 1,00,000.00 03/12 5,088.00
Page Total (Rs) 5,088.00 5,088.00
0.00
5,088.00
Grand Total (Rs) 5,088.00 5,088.00
0.00
5,088.00

RUPEES FIVE THOUSAND EIGHTY-EIGHT ONLY

Sri Vijay Kumar Gupta Duplicate receipt generated online through LIC Portal on
M M B 2/8,S B I Colony 12-Apr-2012 Time : 13:44:27
Sector-P,Aliganj
Lucknow
226024

This receipt is electronically generated and is digitally signed.

Signature Not Verified

Digitally signed by REKHA VARSHNEY
Date: April 12, 2012 1:44:27 PM IST
Reason: Premium Receipt
Location: LIC OF INDIA

Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi

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