Collecting Branch : EPS1 Servicing Branch : LIC of India, Hydeabad C B 6 ,

Taramandal Complex 2nd Floor

Transaction No : 14416493
Sectl Rd,
Date ( Time ): 05/12/2017 ( 20:34:34 ) Hyderabad,500029
bo_eps1@licindia.com
Receipt No : PR1441649300051718
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received With Thanks ` 8,976.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Pathakota Sainiranjankumar

Towards The Following :

Policy No Plan Inst. Premium No Of Inst Total Premium Tax* Branch

Name Term Mode Due From Late Fee Total Amt Next Due
Agency Code D.O.C. Sum Assured Due To CD Charges Reg. No.
(`) (`) (`)
648725145 815 1,744.00 1 1,744.00 39.00 800
P Sai Niranjan 18 Qly 12/17 0.00 1,783.00 03/18
01854800 05/06/2014 1,00,000 12/17 0.00

648725143 815 1,980.00 1 1,980.00 45.00 800

P Sai Niranjan 16 Qly 12/17 0.00 2,025.00 03/18
01854800 05/06/2014 1,00,000 12/17 0.00

648725146 815 1,644.00 1 1,644.00 37.00 800

P Sai Niranjan 19 Qly 12/17 0.00 1,681.00 03/18
01854800 05/06/2014 1,00,000 12/17 0.00

648725147 815 1,555.00 1 1,555.00 35.00 800

P Sai Niranjan 20 Qly 12/17 0.00 1,590.00 03/18
01854800 05/06/2014 1,00,000 12/17 0.00

648725144 815 1,855.00 1 1,855.00 42.00 800

P Sai Niranjan 17 Qly 12/17 0.00 1,897.00 03/18
01854800 05/06/2014 1,00,000 12/17 0.00

Page Total (`) 8,778.00 8,778.00 198.00

0.00 8,976.00
0.00
Grand Total (`) 8,778.00 8,778.00 198.00
0.00 8,976.00
0.00

This receipt is electronically generated.

Har Pal Aapke Saath!

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EIGHT THOUSAND NINE HUNDRED SEVENTY SIX RUPEES AND ZERO PAISE ONLY

Pathakota Sainiranjankumar Consolidated Stamp Duty paid

9-1-34/30/39, 1st Floor,Nr. St.Anthony AMuSh2016/2967/CR747/M1 w.e.f. 30/11/2016
School, Bapu Nagar
Langer House, Hyderabad

500008 Payment Acknowledgement generated through

Online Portal on 05-Dec-17 Time : 20:36:27.
Mobile: 8125134598
Email: niranjan.merits@gmail.com

*Tax here indicates Goods and Service Tax (GST) from 01/07/2017 or Service Tax prior to 01/07/2017.

This receipt is electronically generated.

Har Pal Aapke Saath!

Page 1 of 2