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

Bay No. 71-72 Sector 2

Transaction No : 17998406
Panchkula.,
Date ( Time ): 14/11/2019 ( 19:36:08 ) Panchkula,134109
bo_eps1@licindia.com
Receipt No : PR1799840600011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 3,361.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Bhagwati Prasad

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.
(`) (`) (`)
174630264 75 3,361.00 1 3,361.00 0.00 16N
Bhagwati Prasad 20 HLY 11/19 0.00 0.0 05/20
0155016N 28/05/2005 1,00,000 11/19 0.00 3,361.00 0

Page Total (`) 3,361.00 3,361.00 0.00

0.00 0.00
0.00 3,361.00
Grand Total (`) 3,361.00 3,361.00 0.00
0.00 0.00
0.00 3,361.00

GST borne by LIC of India ` 75.62

THREE THOUSAND THREE HUNDRED SIXTY ONE RUPEES AND ZERO PAISE ONLY

Bhagwati Prasad
H.No 5,New Police Line
Sec 26,Chandigarh

160019 Payment Acknowledgement generated through

Online Portal on 14-Nov-19 Time : 19:38:25.
Mobile: 9417770004
Email: rohitbijalwan86@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!