Collecting Center : A001 Branch Code : 28L

LIC of India, Khalilabad Branch Off 28L

Transaction No. : 77796099 Khalilabad.
Dist Basti
Date ( Time ): 28/12/2017 ( 17:00:49 ) Khalilabad, 0
email: bo_28L@licindia.com
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks Rs. 856.34 from policyholder Shri/Smt.Rabiya Khatoon

towards the following policy/ies

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

Name Term Mode Due Fr Late Fee SGST/UTGST Next Due
Agency D.O.C. Sum Assured Due To CD Chgs Total Amt Reg. No.
Code
293824013 75 836.00 1 836.00 0.22 28L
Khatoon R 20 QLY 09/17 19.90 0.22 12/17
0037528L 14/09/2006 50,000.00 09/17 0.00 856.34
Page Total (Rs) 836.00 836.00 0.22
19.90 0.22
0.00 856.34
Grand Total (Rs) 836.00 836.00 0.22
19.90 0.22
0.00 856.34

RUPEES EIGHT HUNDRED FIFTY-SIX AND THIRTY-FOUR PAISE ONLY

Paid by Cash/Card :856.34
Paid by Cheque :0.00
Cheque No :0
Cheque Date :

Rabiya Khatoon Consolidated Stamp Duty Paid

W/O Mohd Ashraf Khan
Vill/Po-Pach Pokhari
Sant Kabir Nagar For Life Insurance Corporation of India,
272126. Phool Chandra Mishra(0037528L)
Mobile:
Email:

**GST borne by LIC of India is Rs 18.82

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