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

G.T.Road
Transaction No : 19592141
Khurja.,Dist. Bulandshahr.
Date ( Time ): 02/01/2019 ( 14:24:31 ) Khurja,203101
bo_eps1@licindia.com
Receipt No : PR1959214100031819
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 14,161.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Dhirendra Singh

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.
(`) (`) (`)
564139862 108 4,400.00 1 4,400.00 0.00 277
Dhirendra Singh 25 HLY 12/18 0.00 0.00 06/19
04365277 17/12/2011 1,05,000 12/18 0.00 4,400.00

564139864 107 4,909.00 1 4,909.00 0.00 277

Dhirendra Singh 20 HLY 12/18 0.00 0.00 06/19
04365277 17/12/2011 1,05,000 12/18 0.00 4,909.00

564124534 165 4,852.00 1 4,852.00 0.00 277

Dhirendra Singh 20 HLY 12/18 0.00 0.00 06/19
04365277 15/12/2010 2,00,000 12/18 0.00 4,852.00

Page Total (`) 14,161.00 14,161.00 0.00

0.00 0.00
0.00 14,161.00
Grand Total (`) 14,161.00 14,161.00 0.00
0.00 0.00
0.00 14,161.00

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!

GST borne by LIC of India ` 318.64

FOURTEEN THOUSAND ONE HUNDRED SIXTY ONE RUPEES AND ZERO PAISE ONLY

Dhirendra Singh
Consolidated Stamp Duty Paid
S/O Sri Virendra Singh
Vill Post Vaina Via Tappal CSD/64/2018/2366/18 dtd. 26/06/2018
Dt Aligarh

202001 Payment Acknowledgement generated through

Online Portal on 02-Jan-19 Time : 15:08:47.
Mobile: 9783588455
Email: dheerutalan@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!