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

Agra Road.
Transaction No : 25526983
Etah,
Date ( Time ): 03/02/2020 ( 11:16:04 ) Etah,207001
bo_eps1@licindia.com
Receipt No : PR2552698300011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 1,628.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Saroj Kumari

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.
(`) (`) (`)
562860225 75 1,628.00 1 1,628.00 0.00 263
Kumari Saroj 20 HLY 01/20 0.00 0.00 07/20
05128263 27/01/2006 01/20 0.00 1,628.00 09AAACL0582HFZ6
50,000.00

Page Total (`) 1,628.00 1,628.00 0.00

0.00 0.00
0.00 1,628.00
Grand Total (`) 1,628.00 1,628.00 0.00
0.00 0.00
0.00 1,628.00

GST borne by LIC of India ` 36.64

ONE THOUSAND SIX HUNDRED TWENTY EIGHT RUPEES AND ZERO PAISE ONLY

Saroj Kumari
D/O.Sh Siyaram Singh
D/O.Sh Siyaram Singh
Vill.Badholi P.O Gobra Dt Etah

262000 Payment Acknowledgement generated through

Online Portal on 03-Feb-20 Time : 11:17:25.
Mobile: 8533077176
Email: singh.prempal49@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!