Collecting Branch : EPS1 Servicing Branch : LIC of India, Dombivli Br 91G

Dombivli Midc Complex

Transaction No : 22356403
Industrial Estate.,Dombivli East
Date ( Time ): 01/02/2019 ( 17:32:20 ) Dombivli(E),421201
bo_eps1@licindia.com
Receipt No : PR2235640300011819
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 12,130.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Mukund Vithal Joshi

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.
(`) (`) (`)
924801991 165 12,130.00 1 12,130.00 0.00 91G
Mukund Vithal 24 HLY 01/19 0.00 0.00 07/19
0142691G 07/07/2009 5,00,000 01/19 0.00 12,130.00

Page Total (`) 12,130.00 12,130.00 0.00

0.00 0.00
0.00 12,130.00
Grand Total (`) 12,130.00 12,130.00 0.00
0.00 0.00
0.00 12,130.00

GST borne by LIC of India ` 272.92

TWELVE THOUSAND ONE HUNDRED THIRTY RUPEES AND ZERO PAISE ONLY

Mukund Vithal Joshi

Consolidated Stamp Duty Paid
E-301 Shantivan Tower Chs
Azad Nagar No.2 Nr Castle Mill CSD/64/2018/2366/18 dtd. 26/06/2018
Thane (West)

400601 Payment Acknowledgement generated through

Online Portal on 01-Feb-19 Time : 17:33:59.
Mobile: 9869735680
Email: sag2711@rediffmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!