Collecting Branch : EPS1 Servicing Branch : LIC of India, Aurangabad City

Jeevan Prakash
Transaction No : 17664623
Adalat Road.,Aurangabad
Date ( Time ): 10/11/2019 ( 15:52:25 ) Aurangabad,431005
bo_eps1@licindia.com
Receipt No : PR1766462300011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 3,783.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Haseeb.Ahmed S/O J.A.Majeed

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.
(`) (`) (`)
981556305 111 3,783.00 1 3,783.00 0.00 982
Sri Haseeb 28 YLY 10/19 0.00 0.0 10/20
01154945 12/10/1994 3,00,000 10/19 0.00 3,783.00 0

Page Total (`) 3,783.00 3,783.00 0.00

0.00 0.00
0.00 3,783.00
Grand Total (`) 3,783.00 3,783.00 0.00
0.00 0.00
0.00 3,783.00

GST borne by LIC of India ` 85.12

THREE THOUSAND SEVEN HUNDRED EIGHTY THREE RUPEES AND ZERO PAISE ONLY

Haseeb.Ahmed S/O J.A.Majeed

Payment Acknowledgement generated through

Online Portal on 10-Nov-19 Time : 15:54:54.
Mobile: 9423455371
Email: drhaseebahmed@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!