Collecting Branch : EPS1 Servicing Branch : LIC of India, Guntakal Branch

P B No 11
Transaction No : 140722
16-130/C Sub Treasury Rd.,Guntakal
Date ( Time ): 02/04/2019 ( 12:12:21 ) Guntakal,515801
bo_eps1@licindia.com
Receipt No : PR0014072200011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 3,008.20 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Syed Talha Zaid

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.
(`) (`) (`)
657104007 814 2,942.00 1 2,942.00 33.10 65C
Syed Talha Zaid 16 QLY 03/19 0.00 33.10 06/19
0205065C 28/12/2015 1,75,000 03/19 0.00 3,008.20

Page Total (`) 2,942.00 2,942.00 33.10

0.00 33.10
0.00 3,008.20
Grand Total (`) 2,942.00 2,942.00 33.10
0.00 33.10
0.00 3,008.20

THREE THOUSAND EIGHT RUPEES AND TWENTY PAISE ONLY

Syed Talha Zaid

S/O S.Abdul Gaffoor,D.No.7-32-2b,
Bhagya Nagar, Near Sjp High School,
Guntakal Post , Anantapur Dist

515801 Payment Acknowledgement generated through

Online Portal on 02-Apr-19 Time : 12:14:08.
Mobile: 8897166351
Email: zsyed09@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!