Collecting Branch : EPS1 Servicing Branch : LIC of India, Rajahmundry Br

P B No-30 36-6-13 South Mansion

Transaction No : 25966056
Opp Saikrishna Theatre
Date ( Time ): 10/03/2019 ( 15:30:09 ) Rajamundry,533101
bo_eps1@licindia.com
Receipt No : PR2596605600011819
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 291.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Pothunuri Mangatayaru

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.
(`) (`) (`)
800856812 111 291.00 1 291.00 0.00 676
Pothunuri 30 QLY 02/19 0.00 0.00 05/19
0014169M 14/08/1998 1,00,000 02/19 0.00 291.00

Page Total (`) 291.00 291.00 0.00

0.00 0.00
0.00 291.00
Grand Total (`) 291.00 291.00 0.00
0.00 0.00
0.00 291.00

GST borne by LIC of India ` 6.54

TWO HUNDRED NINETY ONE RUPEES AND ZERO PAISE ONLY

Pothunuri Mangatayaru
Staff Nurse, E S I Hospital
Sriram Nagar
Rajahmundry

533105 Payment Acknowledgement generated through

Online Portal on 10-Mar-19 Time : 15:32:24.
Mobile: 9948674203
Email: mangatayaru.madapalli@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!