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

P B No 31
Transaction No : 11213137
10/171 Gandhi Rd Proddatur.,Dt
Date ( Time ): 13/09/2018 ( 18:46:14 ) Proddatur,516360
bo_eps1@licindia.com
Receipt No : PR1121313700011819
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 1,519.11 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Prabhakar Reddy Peram

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.
(`) (`) (`)
656925794 164 1,505.00 1 1,505.00 1.08 663
Peram 25 YLY 08/18 11.95 1.08 08/19
03464663 14/08/2013 5,00,000 08/18 0.00 1,519.11

Page Total (`) 1,505.00 1,505.00 1.08

11.95 1.08
0.00 1,519.11
Grand Total (`) 1,505.00 1,505.00 1.08
11.95 1.08
0.00 1,519.11

GST borne by LIC of India ` 270.90

ONE THOUSAND FIVE HUNDRED NINETEEN RUPEES AND ELEVEN PAISE ONLY

Prabhakar Reddy Peram

S/O.P.Rama Subba Reddy,
H.No:1-7 22/3,Nitturu Vi ,
Yadiki Mdl ,Anantapur Dt .

515408 Payment Acknowledgement generated through

Online Portal on 13-Sep-18 Time : 18:48:13.
Mobile: 9493273959
Email: prabhakar.peram@yahoo.in

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!