Collecting Branch : EPS1

E-mail : bo_eps1@licindia.com
Phone : +91-022-1251

Servicing Branch : 583

LIC of India, Bhubaneswar Br I
Opp Raj Bhawan New Capital
Lic Building Unit-7.
Bhubaneswar
Bhubaneshwar I
751001

Transaction No. : PR0166198400011617

Date ( Time ): 09/05/2016 ( 12:27:18 )

RENEWAL PREMIUM ACKNOWLEDGEMENT

Received with thanks Rs. 2882.80 through Payment Gateway over the Internet from:
Smt./Ms./Shri : Debswarup Rath
Towards the following
Policy No
Name
Agency Code
598324522

Plan
Term
D.O.C.
149
D Rath
76
05585583
20/12/2011
Page Total (Rs)

Grand Total (Rs)

Inst. Prem(Rs)
Mode
Sum Assured
2,773.00
HLY
1,00,000.00
2,773.00

2,773.00

No Of Inst
Due Fr
Due To
1
12/15
12/15

Total Premium
Late Fee
2,773.00
109.80
2,773.00
109.80
2,773.00
109.80

Service Tax
Edu Cess
Total Amt
0.00
0.00
2,882.80
0.00
0.00
2,882.80
0.00
0.00
2,882.80

Branch
Next Due
583
06/16

RUPEES TWO THOUSAND EIGHT HUNDRED EIGHTY-TWO AND EIGHTY PAISE ONLY
Debswarup Rath
2ra(F)-15/1,Unit-Ix(F)
Bhubaneswar
751022

Payment Acknowledgement generated through Online

Portal on 09-May-2016 Time : 12:29:44.

This receipt is electronically generated.

Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi

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