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

Near Rotary Eye Hospital

Transaction No : 21874548
Bidanasi ,
Date ( Time ): 27/01/2019 ( 20:21:31 ) Cuttack,753014
bo_eps1@licindia.com
Receipt No : PR2187454800011819
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 25,102.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Swagat Das

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.
(`) (`) (`)
589466805 162 25,102.00 1 25,102.00 0.00 581
Swagat Das 25 YLY 12/18 0.00 0.00 12/19
04204581 27/12/2008 5,00,000 12/18 0.00 25,102.00

Page Total (`) 25,102.00 25,102.00 0.00

0.00 0.00
0.00 25,102.00
Grand Total (`) 25,102.00 25,102.00 0.00
0.00 0.00
0.00 25,102.00

GST borne by LIC of India ` 564.80

TWENTY FIVE THOUSAND ONE HUNDRED TWO RUPEES AND ZERO PAISE ONLY

Swagat Das
Consolidated Stamp Duty Paid
Qr No-Hig-183, Dharma Vihar
Near Khandagiri Chhack CSD/64/2018/2366/18 dtd. 26/06/2018
Bhubaneswar

751030 Payment Acknowledgement generated through

Online Portal on 27-Jan-19 Time : 20:25:03.
Mobile: 9799732645
Email: swagatdas22@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!