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

Railway Feeder Road Tadpatri

Transaction No : 19997960
Dt Anantapur.,Andhra Pradesh
Date ( Time ): 15/02/2018 ( 19:32:49 ) Tadpatri,515411
bo_eps1@licindia.com
Receipt No : PR1999796000011718
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 3,159.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : P Bhagya Lakshmi

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.
(`) (`) (`)
655953321 165 3,159.00 1 3,159.00 0.00 65L
P Bhagya 20 YLY 01/18 0.00 0.00 01/19
0218365L 28/01/2011 62,500.00 01/18 0.00 3,159.00

Page Total (`) 3,159.00 3,159.00 0.00

0.00 0.00
0.00 3,159.00
Grand Total (`) 3,159.00 3,159.00 0.00
0.00 0.00
0.00 3,159.00

GST borne by LIC of India ` 71.08

THREE THOUSAND ONE HUNDRED FIFTY NINE RUPEES AND ZERO PAISE ONLY

P Bhagya Lakshmi
W/O P.Rama Subba Reddy
23/2 Nitturu V&Po
Yadiki Mdl,. Anantapur Dist.

515408 Payment Acknowledgement generated through

Online Portal on 15-Feb-18 Time : 19:44:49.
Mobile: 9493273959
Email: prabhakar.peram@yahoo.in

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!