Collecting Branch : EPS1 Servicing Branch : LIC of India, Peelamedu Br

United India Bldg Annexe

Transaction No : 3278079
Ground Floor Avanashi Road P B
Date ( Time ): 14/05/2019 ( 11:07:39 ) Peelamedu ,641018
bo_eps1@licindia.com
Receipt No : PR0327807900011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 1,445.82 through Payment Gateway over the Internet from:

Smt./Ms./Shri : A.Afrin Banu

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.
(`) (`) (`)
308147765 815 1,414.00 1 1,414.00 15.91 76V
A.Afrin Banu 25 QLY 05/19 0.00 15.91 08/19
0284676V 14/02/2018 1,20,000 05/19 0.00 1,445.82

Page Total (`) 1,414.00 1,414.00 15.91

0.00 15.91
0.00 1,445.82
Grand Total (`) 1,414.00 1,414.00 15.91
0.00 15.91
0.00 1,445.82

ONE THOUSAND FOUR HUNDRED FORTY FIVE RUPEES AND EIGHTY TWO PAISE ONLY

A.Afrin Banu
C31/2 Race Course Colony
Madurai

625002 Payment Acknowledgement generated through

Online Portal on 14-May-19 Time : 11:10:40.
Mobile: 8610119208
Email: afrinbanum90@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!