Collecting Branch : EPS1 Servicing Branch : LIC of India, Rajkot CBO III

Jeevan Prakash
Transaction No : 28604271
2nd Flr Tagore Marg.,Rajkot
Date ( Time ): 12/01/2018 ( 06:39:44 ) Rajkot,360001
bo_eps1@licindia.com
Receipt No : PR1869427100011688
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 2,201.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Nikunj Rameshbhai Hirpara

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.
(`) (`) (`)

814628404 164 2,201.00 1 2,201.00 0.00 810

Nikunj kumar 25 YLY 03/18 0.00 0.00 03/19
00814810 14/03/2009 9,00,000 03/18 0.00 2,201.00

Page Total () 2,201.00 2,201.00 0.00

0.00 0.00
0.00 2,201.00
Grand Total (`) 2,201.00 2,201.00 0.00
0.00 0.00
2,201.00
0.00

TWO THOUSAND TWO HUNDRED ONE RUPEES AND ZERO PAISE ONLY

Nikunj Rameshbhai Hirpara

33.Sanidhya Bungalows.150 Feet Ring Rd.,
Opp-Balaji Hall, At-Rajkot-4

360004 Payment Acknowledgement generated through

Online Portal on 12-Jan-18 Time : 07:16:43.
Mobile: 919998183255
Email: nikunjhirpara@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!