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

Kotawala Bldg
Transaction No : 25379531
Behind Nawab Ki Haweli Tripolia
Date ( Time ): 04/03/2019 ( 21:53:18 ) Jaipur,302002
bo_eps1@licindia.com
Receipt No : PR2537953100011819
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 26,939.80 through Payment Gateway over the Internet from:

Smt./Ms./Shri : MP
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.
(`) (`) (`)
478254159 815 26,347.00 1 26,347.00 296.40 325
Priyanshu Mittal 21 YLY 03/19 0.00 296.40 03/20
03198325 28/03/2016 5,00,000 03/19 0.00 26,939.80

Page Total (`) 26,347.00 26,347.00 296.40

0.00 296.40
0.00 26,939.80
Grand Total (`) 26,347.00 26,347.00 296.40
0.00 296.40
0.00 26,939.80

TWENTY SIX THOUSAND NINE HUNDRED THIRTY NINE RUPEES AND EIGHTY PAISE ONLY

MP
23/155,Swarn Path
Mansarovar
Jaipur

302020 Payment Acknowledgement generated through

Online Portal on 09-Apr-19 Time : 12:14:19.
Mobile: 9763006839
Email: priyanshu1710@yahoo.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!