Collecting Branch : EPS1 Servicing Branch : LIC of India, Bangalore City

United India Bldg

Transaction No : 19105673
1st Floor J C Rd.,Bangalore
Date ( Time ): 04/02/2018 ( 22:06:38 ) Bangalore,560002
bo_eps1@licindia.com
Receipt No : PR1910567300011718
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 1,980.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Gururajan Gururajan Gururajan

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.
(`) (`) (`)
616839281 149 1,980.00 1 1,980.00 0.00 611
R,Gururajan 63 QLY 02/18 0.00 0.00 05/18
03452643 05/11/2012 1,00,000 02/18 0.00 1,980.00

Page Total (`) 1,980.00 1,980.00 0.00

0.00 0.00
0.00 1,980.00
Grand Total (`) 1,980.00 1,980.00 0.00
0.00 0.00
0.00 1,980.00

GST borne by LIC of India ` 44.56

ONE THOUSAND NINE HUNDRED EIGHTY RUPEES AND ZERO PAISE ONLY

Gururajan Gururajan Gururajan

No.1320, A Block,
Sahakar Nagar,Byatarayanapura,
Bangalore

560092 Payment Acknowledgement generated through

Online Portal on 04-Feb-18 Time : 22:08:19.
Mobile: 9739011749
Email: gururajan_r12@yahoo.co.in

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!