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

K B N Complex M S K Mill Road

Transaction No : 29832468
Asghari Chambers
Date ( Time ): 18/03/2020 ( 13:10:57 ) Gulbarga,585102
bo_eps1@licindia.com
Receipt No : PR2983246800011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 26,854.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Manisha W/O.Santosh Bomshetty

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.
(`) (`) (`)
665824473 90 26,854.00 1 26,854.00 0.00 66M
Manisha 18 YLY 03/20 0.00 0.00 03/21
02621646 19/03/2013 03/20 0.00 26,854.00 29AAACL0582H2ZH
5,00,000

Page Total (`) 26,854.00 26,854.00 0.00

0.00 0.00
0.00 26,854.00
Grand Total (`) 26,854.00 26,854.00 0.00
0.00 0.00
0.00 26,854.00

GST borne by LIC of India ` 604.22

TWENTY SIX THOUSAND EIGHT HUNDRED FIFTY FOUR RUPEES AND ZERO PAISE ONLY

Manisha W/O.Santosh Bomshetty

Consolidated Stamp Duty Paid
H.No.12 Sy No.11/Aa Nr Govt High School
Hallikhed B CSD/328/2019/646/19 DTD.15/02/2019
R/.Hallikhed Tq Humnabad Dist Bida

585414 Payment Acknowledgement generated through

Online Portal on 18-Mar-20 Time : 13:13:44.
Mobile: 9764482648
Email: always.santosh@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!