Collecting Branch : EPS1

E-mail : bo_eps1@licindia.com
Phone : +91-022-1251
Transaction No. : PR1512679700041415
Date ( Time ): 20/03/2015 ( 11:01:36 )

Servicing Branch : 809

LIC of India, Trichy CABr Office
K R T Building No.33 Promenade Road
Cantonment P B No-109 Trichy
Tamilnadu
Trichy
620001

RENEWAL PREMIUM ACKNOWLEDGEMENT

Received with thanks Rs. 13720.00 through Payment Gateway over the Internet from:
Smt./Ms./Shri : Mr.K.Gnana Selvam

&.

Towards the following

Policy No
Name
Agency Code
862090390

Plan
Term
D.O.C.
89
Selvam Gs
20
030025866
28/08/2000
862090391
89
Selvam Gs
20
030025866
28/08/2000
862090392
89
030310866
20
28/08/2000
862090393
89
Selvam Gs
20
030310866
28/08/2000
Page Total (Rs)

Inst. Prem(Rs)
Mode
Sum Assured
3,430.00
HLY
1,00,000.00
3,430.00
HLY
1,00,000.00
3,430.00
HLY
1,00,000.00
3,430.00
HLY
1,00,000.00
13,720.00

Grand Total (Rs)

No Of Inst
Due Fr
Due To
1
02/15
02/15
1
02/15
02/15
1
02/15
02/15
1
02/15
02/15

Total Premium
Late Fee
3,430.00
0.00
3,430.00
0.00
3,430.00
0.00
3,430.00
0.00
13,720.00
0.00

13,720.00

13,720.00
0.00

Service Tax
Edu Cess
Total Amt
0.00
0.00
3,430.00
0.00
0.00
3,430.00
0.00
0.00
3,430.00
0.00
0.00
3,430.00
0.00
0.00
13,720.00
0.00
0.00
13,720.00

Branch
Next Due
809
08/15
809
08/15
809
08/15
809
08/15

RUPEES THIRTEEN THOUSAND SEVEN HUNDRED TWENTY ONLY

Mr.K.Gnana Selvam &.
No.41, 2nd Cross, I Main Road, Vakil
Housing Lay Out, Hosur Hills Sooda
Chandra Vill, Chennathur Po Hosur
635109

Payment Acknowledgement generated through Online

Portal on 20-Mar-2015 Time : 11:04:15.

This receipt is electronically generated.

Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi

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