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Collecting Branch : EPS1 Servicing Branch : LIC of India, Bhawani Patna

Main Rd Bhawani Patna.


Transaction No : 9030434
Dt Kalahandi Orissa,
Date ( Time ): 30/07/2019 ( 02:23:46 ) Bhawanipatna,766011
bo_eps1@licindia.com
Receipt No : PR0903043400011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 7,452.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Jasmita Meher


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.
(`) (`) (`)
573750360 179 7,452.00 1 7,452.00 0.00 509
Jasmita Meher 20 HLY 07/19 0.00 0.0 01/20
01671509 11/07/2012 07/19 0.00 7,452.00 21AAACL0582H1ZY
4,00,000

Page Total (`) 7,452.00 7,452.00 0.00


0.00 0.00
0.00 7,452.00
Grand Total (`) 7,452.00 7,452.00 0.00
0.00 0.00
0.00 7,452.00

GST borne by LIC of India ` 167.68


SEVEN THOUSAND FOUR HUNDRED FIFTY TWO RUPEES AND ZERO PAISE ONLY

Jasmita Meher
D/O Bimbadhar Meher
At/Po Chichaiguda,Via Junagarh,
Dist Kalahandi,State Odisha

766014 Payment Acknowledgement generated through


Online Portal on 07-Jan-20 Time : 01:21:04.
Mobile: 9945345454
Email: jasmita.meher@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!

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