Collecting Branch : EPS1 Servicing Branch : 467

E-mail : bo_eps1@licindia.com LIC of India, Contai Br Office

Phone : +91-022-1251 Manohar Chak
Post-Contai Dist-Midnapore.
Transaction No. : PR0485558600011415 West Bengal
Contai
Date ( Time ): 12/08/2014 ( 20:59:28 ) 721401

RENEWAL PREMIUM RECEIPT

Received with thanks Rs. 3600.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Dipankar Sahu

Towards the following

Policy No Plan Inst. Prem(Rs) No Of Inst Total Premium Service Tax Branch
Name Term Mode Due Fr Late Fee Edu Cess Next Due
Agency Code D.O.C. Sum Assured Due To Total Amt
498816866 149 3,600.00 1 3,600.00 0.00 467
D Sahu 79 QLY 08/14 0.00 0.00 11/14
04294467 14/08/2009 2,00,000.00 08/14 3,600.00
Page Total (Rs) 3,600.00 3,600.00 0.00
0.00 0.00
3,600.00
Grand Total (Rs) 3,600.00 3,600.00 0.00
0.00 0.00
3,600.00

RUPEES THREE THOUSAND SIX HUNDRED ONLY

Dipankar Sahu
S/O-Kanak Baran Sahu
At- Akhuabari Po-Brajalalchak
Dt-Purba Medinipur
721659

This receipt is electronically generated.

Signature Not Verified

Digitally signed by Rekha Varshney
Date: August 12, 2014 8:59:28 PM IST
Reason: Premium Receipt
Location: LIC OF INDIA

Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi

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