Collecting Branch : EPS1 Servicing Branch : LIC of India, Guntur Br Office I,

P B No 229
Transaction No : 18987117
Arundel Pet.,Guntur Andhra Pradesh
Date ( Time ): 28/11/2019 ( 12:29:42 ) Guntur I,522002
bo_eps1@licindia.com
Receipt No : PR1898711700011922
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 85,250.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : MOHAMMED SHANAWAZ

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.
(`) (`) (`)
654279209 149 85,250.00 1 85,250.00 0.00 688
SHANAWAZ 73 YLY 12/19 0.00 0.0 12/20
03243655 06/12/2006 8,00,000 12/19 0.00 85,250.00 0

Page Total (`) 85,250.00 85,250.00 0.00

0.00 0.00
0.00 85,250.00
Grand Total (`) 85,250.00 85,250.00 0.00
0.00 0.00
0.00 85,250.00

GST borne by LIC of India ` 572.94

EIGHTY FIVE THOUSAND TWO HUNDRED FIFTY RUPEES AND ZERO PAISE ONLY

Mohammed Shanawaz
Consolidated Stamp Duty Paid
S/O.Nabi Rasool
H.No.4-20-40/1,Siddhartha Nagar,6th CSD/328/2019/646/19 DTD.15/02/2019
Ring Road,Guntur.

522006 Payment Acknowledgement generated through

Online Portal on 28-Nov-19 Time : 12:31:58.
Mobile: 9000083212
Email: moh.shanz@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!