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

Sheetal Shopping Centre

Transaction No : 8031655
Station Road.,Dhanera
Date ( Time ): 01/08/2018 ( 03:45:35 ) Dhanera,385310
bo_eps1@licindia.com
Receipt No : PR0803165500011819
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 17,036.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Tajne Sachin Krishna

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.
(`) (`) (`)
854361191 179 17,036.00 1 17,036.00 0.00 8026
Tajne Sachin 20 YLY 08/18 0.00 0.00 08/19
002168026 28/08/2007 5,00,000 08/18 0.00 17,036.00

Page Total (`) 17,036.00 17,036.00 0.00

0.00 0.00
0.00 17,036.00
Grand Total (`) 17,036.00 17,036.00 0.00
0.00 0.00
0.00 17,036.00

GST borne by LIC of India ` 383.32

SEVENTEEN THOUSAND THIRTY SIX RUPEES AND ZERO PAISE ONLY

Tajne Sachin Krishna

Consolidated Stamp Duty Paid
E/150,Temporary Sector,
N.T.P.C.Talcher Thermal, CSD/64/2018/2366/18 dtd. 26/06/2018
Talcher,Angul,Odisha.

759101 Payment Acknowledgement generated through

Online Portal on 01-Aug-18 Time : 03:47:01.
Mobile: 9437556589
Email: sachintajne007@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!