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

Main Road Parvathipuram


Transaction No : 77005
Dt Srikakulam.,A P
Date ( Time ): 01/04/2019 ( 17:35:16 ) Parvathipuram,532501
bo_eps1@licindia.com
Receipt No : PR0007700500011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 2,270.98 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Singupuram Madhusudhanarao


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.
(`) (`) (`)
808732083 815 2,221.00 1 2,221.00 24.99 69B
Singupuram 21 MLY 03/19 0.00 24.99 04/19
0382769B 28/10/2017 5,00,000 03/19 0.00 2,270.98

Page Total (`) 2,221.00 2,221.00 24.99


0.00 24.99
0.00 2,270.98
Grand Total (`) 2,221.00 2,221.00 24.99
0.00 24.99
0.00 2,270.98

TWO THOUSAND TWO HUNDRED SEVENTY RUPEES AND NINETY EIGHT PAISE ONLY

Singupuram Madhusudhanarao
S/O S Mohanarao
4-50, Jagannadhapuram, Vill,P.O,
Narasingapalle, Srikakulam-Dt

532201 Payment Acknowledgement generated through


Online Portal on 01-Apr-19 Time : 17:37:13.
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Email: madhucivil784@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!