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

Post-Motipur.
Transaction No : 27855615
Muzaffarpur,Bihar
Date ( Time ): 28/02/2020 ( 15:01:37 ) Motipur,0
bo_eps1@licindia.com
Receipt No : PR2785561500081920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 2,986.04 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Sumit Kumar

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.
(`) (`) (`)
575809694 103 1,388.00 2 2,776.00 16.02 53H
Sumit Kumar 20 HLY 03/19 178.00 16.02 03/20
0078453H 22/03/2012 09/19 0.00 2,986.04 10AAACL0582H2Z0
50,000.00

Page Total (`) 1,388.00 2,776.00 16.02

178.00 16.02
0.00 2,986.04
Grand Total (`) 1,388.00 2,776.00 16.02
178.00 16.02
0.00 2,986.04

GST borne by LIC of India ` 62.46

TWO THOUSAND NINE HUNDRED EIGHTY SIX RUPEES AND FOUR PAISE ONLY

Sumit Kumar
S/O- Sunil Kumar
At- Mohala Miscot Po- Motihari
Dt- East Champaran

845401 Payment Acknowledgement generated through

Online Portal on 28-Feb-20 Time : 15:03:59.
Mobile: 9582943568
Email: tarunsumit@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!

 Collecting Branch : EPS1 Servicing Branch : LIC of India, Motipur Branch
Post-Motipur.
Transaction No : 27855615
Muzaffarpur,Bihar
Date ( Time ): 28/02/2020 ( 15:01:37 ) Motipur,0
bo_eps1@licindia.com
Receipt No : PR2785561500081920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 4,107.10 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Sumit Kumar

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.
(`) (`) (`)
575809696 179 1,909.00 2 3,818.00 22.05 53H
Sumit Kumar 20 HLY 03/19 245.00 22.05 03/20
0078453H 22/03/2012 09/19 0.00 4,107.10 10AAACL0582H2Z0
1,00,000

Page Total (`) 1,909.00 3,818.00 22.05

245.00 22.05
0.00 4,107.10
Grand Total (`) 1,909.00 3,818.00 22.05
245.00 22.05
0.00 4,107.10

GST borne by LIC of India ` 85.90

FOUR THOUSAND ONE HUNDRED SEVEN RUPEES AND TEN PAISE ONLY

Sumit Kumar
S/O- Sunil Kumar
At- Mohala Miscot Po- Motihari
Dt- East Champaran

845401 Payment Acknowledgement generated through

Online Portal on 28-Feb-20 Time : 15:03:59.
Mobile: 9582943568
Email: tarunsumit@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!

 Collecting Branch : EPS1 Servicing Branch : LIC of India, Motipur Branch
Post-Motipur.
Transaction No : 27855615
Muzaffarpur,Bihar
Date ( Time ): 28/02/2020 ( 15:01:37 ) Motipur,0
bo_eps1@licindia.com
Receipt No : PR2785561500081920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 1,743.57 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Sumit Kumar

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.
(`) (`) (`)
576671036 75 1,651.00 1 1,651.00 7.06 53H
Sumit Kumar 20 HLY 09/19 78.45 7.06 03/20
0078453H 13/03/2013 09/19 0.00 1,743.57 10AAACL0582H2Z0
50,000.00

Page Total (`) 1,651.00 1,651.00 7.06

78.45 7.06
0.00 1,743.57
Grand Total (`) 1,651.00 1,651.00 7.06
78.45 7.06
0.00 1,743.57

GST borne by LIC of India ` 37.14

ONE THOUSAND SEVEN HUNDRED FORTY THREE RUPEES AND FIFTY SEVEN PAISE ONLY

Sumit Kumar
S/O Sunil Kumar
Mohalla Miscot Po Motihari
Dt East Champaran

845401 Payment Acknowledgement generated through

Online Portal on 28-Feb-20 Time : 15:03:59.
Mobile: 9582943568
Email: tarunsumit@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!

 Collecting Branch : EPS1 Servicing Branch : LIC of India, Motipur Branch
Post-Motipur.
Transaction No : 27855615
Muzaffarpur,Bihar
Date ( Time ): 28/02/2020 ( 15:01:37 ) Motipur,0
bo_eps1@licindia.com
Receipt No : PR2785561500081920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 2,033.98 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Sumit Kumar

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.
(`) (`) (`)
576671038 179 1,926.00 1 1,926.00 8.24 53H
Sumit Kumar 20 HLY 09/19 91.50 8.24 03/20
0078453H 13/03/2013 09/19 0.00 2,033.98 10AAACL0582H2Z0
1,00,000

Page Total (`) 1,926.00 1,926.00 8.24

91.50 8.24
0.00 2,033.98
Grand Total (`) 1,926.00 1,926.00 8.24
91.50 8.24
0.00 2,033.98

GST borne by LIC of India ` 43.34

TWO THOUSAND THIRTY THREE RUPEES AND NINETY EIGHT PAISE ONLY

Sumit Kumar
S/O Sunil Kumar
Mohalla Miscot Po Motihari
Dt East Champaran

845401 Payment Acknowledgement generated through

Online Portal on 28-Feb-20 Time : 15:03:59.
Mobile: 9582943568
Email: tarunsumit@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!

 Collecting Branch : EPS1 Servicing Branch : LIC of India, Motipur Branch
Post-Motipur.
Transaction No : 27855615
Muzaffarpur,Bihar
Date ( Time ): 28/02/2020 ( 15:01:37 ) Motipur,0
bo_eps1@licindia.com
Receipt No : PR2785561500081920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 2,616.08 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Sumit Kumar

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.
(`) (`) (`)
575809693 14 1,216.00 2 2,432.00 14.04 53H
Sumit Kumar 21 HLY 03/19 156.00 14.04 03/20
0078453H 22/03/2012 09/19 0.00 2,616.08 10AAACL0582H2Z0
50,000.00

Page Total (`) 1,216.00 2,432.00 14.04

156.00 14.04
0.00 2,616.08
Grand Total (`) 1,216.00 2,432.00 14.04
156.00 14.04
0.00 2,616.08

GST borne by LIC of India ` 54.72

TWO THOUSAND SIX HUNDRED SIXTEEN RUPEES AND EIGHT PAISE ONLY

Sumit Kumar
S/O- Sunil Kumar
At- Mohala Miscot Po- Motihari
Dt- East Champaran

845401 Payment Acknowledgement generated through

Online Portal on 28-Feb-20 Time : 15:03:59.
Mobile: 9582943568
Email: tarunsumit@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!

 Collecting Branch : EPS1 Servicing Branch : LIC of India, Motipur Branch
Post-Motipur.
Transaction No : 27855615
Muzaffarpur,Bihar
Date ( Time ): 28/02/2020 ( 15:01:37 ) Motipur,0
bo_eps1@licindia.com
Receipt No : PR2785561500081920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 3,544.16 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Sumit Kumar

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.
(`) (`) (`)
575809695 75 1,647.00 2 3,294.00 19.08 53H
Sumit Kumar 20 HLY 03/19 212.00 19.08 03/20
0078453H 22/03/2012 09/19 0.00 3,544.16 10AAACL0582H2Z0
50,000.00

Page Total (`) 1,647.00 3,294.00 19.08

212.00 19.08
0.00 3,544.16
Grand Total (`) 1,647.00 3,294.00 19.08
212.00 19.08
0.00 3,544.16

GST borne by LIC of India ` 74.12

THREE THOUSAND FIVE HUNDRED FORTY FOUR RUPEES AND SIXTEEN PAISE ONLY

Sumit Kumar
S/O- Sunil Kumar
At- Mohala Miscot Po- Motihari
Dt- East Champaran

845401 Payment Acknowledgement generated through

Online Portal on 28-Feb-20 Time : 15:03:59.
Mobile: 9582943568
Email: tarunsumit@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!

 Collecting Branch : EPS1 Servicing Branch : LIC of India, Motipur Branch
Post-Motipur.
Transaction No : 27855615
Muzaffarpur,Bihar
Date ( Time ): 28/02/2020 ( 15:01:37 ) Motipur,0
bo_eps1@licindia.com
Receipt No : PR2785561500081920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 1,473.24 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Sumit Kumar

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.
(`) (`) (`)
576671035 103 1,395.00 1 1,395.00 5.97 53H
Sumit Kumar 20 HLY 09/19 66.30 5.97 03/20
0078453H 13/03/2013 09/19 0.00 1,473.24 10AAACL0582H2Z0
50,000.00

Page Total (`) 1,395.00 1,395.00 5.97

66.30 5.97
0.00 1,473.24
Grand Total (`) 1,395.00 1,395.00 5.97
66.30 5.97
0.00 1,473.24

GST borne by LIC of India ` 31.38

ONE THOUSAND FOUR HUNDRED SEVENTY THREE RUPEES AND TWENTY FOUR PAISE ONLY

Sumit Kumar
S/O Sunil Kumar
Mohalla Miscot Po Motihari
Dt East Champaran

845401 Payment Acknowledgement generated through

Online Portal on 28-Feb-20 Time : 15:03:59.
Mobile: 9582943568
Email: tarunsumit@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!

 Collecting Branch : EPS1 Servicing Branch : LIC of India, Motipur Branch
Post-Motipur.
Transaction No : 27855615
Muzaffarpur,Bihar
Date ( Time ): 28/02/2020 ( 15:01:37 ) Motipur,0
bo_eps1@licindia.com
Receipt No : PR2785561500081920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 1,287.39 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Sumit Kumar

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.
(`) (`) (`)
576671037 14 1,219.00 1 1,219.00 5.22 53H
Sumit Kumar 21 HLY 09/19 57.95 5.22 03/20
0078453H 13/03/2013 09/19 0.00 1,287.39 10AAACL0582H2Z0
50,000.00

Page Total (`) 1,219.00 1,219.00 5.22

57.95 5.22
0.00 1,287.39
Grand Total (`) 1,219.00 1,219.00 5.22
57.95 5.22
0.00 1,287.39

GST borne by LIC of India ` 27.42

ONE THOUSAND TWO HUNDRED EIGHTY SEVEN RUPEES AND THIRTY NINE PAISE ONLY

Sumit Kumar
S/O Sunil Kumar
Mohalla Miscot Po Motihari
Dt East Champaran

845401 Payment Acknowledgement generated through

Online Portal on 28-Feb-20 Time : 15:03:59.
Mobile: 9582943568
Email: tarunsumit@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!