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Collecting Branch : EPS1 Servicing Branch : 790

E-mail : bo_eps1@licindia.com LIC of India, Chitradurga Branch Office


Phone : +91-022-1251 Near K.S.R.T.C.Dept.
P.B.Road
Transaction No. : PR0303621700011617 Chitradurga
Chitradurga
Date ( Time ): 12/06/2016 ( 17:29:44 ) 577501

RENEWAL PREMIUM RECEIPT

Received with thanks Rs. 1465.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : J.Vinay

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
629202625 149 1,431.00 1 1,431.00 0.00 790
Vinay J 73 QLY 03/16 34.00 0.00 06/16
02355790 28/03/2009 1,00,000.00 03/16 1,465.00
Page Total (Rs) 1,431.00 1,431.00 0.00
34.00 0.00
1,465.00
Grand Total (Rs) 1,431.00 1,431.00 0.00
34.00 0.00
1,465.00

RUPEES ONE THOUSAND FOUR HUNDRED SIXTY-FIVE ONLY

J.Vinay
S/O D.B.Jagadeeshappa
Vybhava Vnilaya,Nrupathunga Extn,
Bank Colony,Chitradurga
577501

This receipt is electronically generated.

Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi


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