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Collecting Branch : EPS1 Servicing Branch : 41L

E-mail : bo_eps1@licindia.com LIC of India,Burrabazar Branch Office,


Phone : +91-022-1251 9 5th Floor Bombay Mutual Building
Brabourne Road Kolkata
Transaction No. : PR0445228800021011 West Bengal
Burra Bazar
Date ( Time ): 04/03/2011 ( 10:20:37 ) 700001

RENEWAL PREMIUM RECEIPT

Received with thanks Rs. 7861.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Babita Prasad

Towards the following

Policy No Plan Inst. Prem(Rs) No Of Inst Total Premium Branch


Name Term Mode Due Fr Late Fee Next Due
Agency Code D.O.C. Sum Assured Due To Total Amt
419074935 149 4,132.00 1 4,132.00 41L
Prasad B 78 YLY 01/11 27.50 01/12
1039241L 28/01/2008 1,00,000.00 01/11 4,159.50
419074936 179 3,677.00 1 3,677.00 41L
Prasad B 20 YLY 01/11 24.50 01/12
1039241L 28/01/2008 1,00,000.00 01/11 3,701.50
Page Total (Rs) 7,809.00 7,809.00
52.00
7,861.00
Grand Total (Rs) 7,809.00 7,809.00
52.00
7,861.00

RUPEES SEVEN THOUSAND EIGHT HUNDRED SIXTY-ONE ONLY

Babita Prasad Duplicate receipt generated online through LIC Portal on


Vill-Daluwa,P.O-Shuklapuri, 04-Mar-2011 Time : 10:46:55
Dist-Gorakhpur,
Uttarpradesh.
273402

This receipt is electronically generated and is digitally signed.

Signature Not Verified


Digitally signed by REKHA VARSHNEY
Date: March 4, 2011 10:46:55 AM IST
Reason: Premium Receipt
Location: LIC OF INDIA

Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi


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