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

Main Rd
Transaction No : 29831548
P O & Dist Purulia.,W B
Date ( Time ): 18/03/2020 ( 13:03:38 ) Purulia,723101
bo_eps1@licindia.com
Receipt No : PR2983154800011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 33,980.74 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Sailen Kumar Gope

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.
(`) (`) (`)
401799273 814 33,233.00 1 33,233.00 373.87 569
Sailen Kumar 33 YLY 03/20 0.00 373.87 03/21
06036569 17/03/2018 03/20 0.00 33,980.74 19AAACL0582H1ZJ
12,00,000

Page Total (`) 33,233.00 33,233.00 373.87

0.00 373.87
0.00 33,980.74
Grand Total (`) 33,233.00 33,233.00 373.87
0.00 373.87
0.00 33,980.74

THIRTY THREE THOUSAND NINE HUNDRED EIGHTY RUPEES AND SEVENTY FOUR PAISE ONLY

Sailen Kumar Gope

Consolidated Stamp Duty Paid
S/O-Lt Nabin Gope
Vill-Keshargarh Po-Rakab CSD/328/2019/646/19 DTD.15/02/2019
Ps-Hura Dist-Purulia

723130 Payment Acknowledgement generated through

Online Portal on 18-Mar-20 Time : 13:05:45.
Mobile: 9437487236
Email: gopi.sailen@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!