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

Basudebpur Post Khanjanchak.

Transaction No : 9886013
Dist Midnapore,
Date ( Time ): 15/06/2020 ( 19:31:54 ) Haldia,721507
bo_eps1@licindia.com
Receipt No : PR0988601300012021
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 2,108.80 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Swarnadeep Sen

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
Revival D.O.C. Sum Assured Due To CD Charges Total Amt Reg. No.
(Yes/No) (`) (`) (`)
408212002 814 463.00 4 1,852.00 54.90 43A
Swarnadeep 19 MLY 03/20 22.00 54.90 07/20
Yes 13/01/2020 06/20 125.00 2,108.80 19AAACL0582H1ZJ
1,00,000

Page Total (`) 463.00 1,852.00 54.90

22.00 54.90
125.00 2,108.80
Grand Total (`) 463.00 1,852.00 54.90
22.00 54.90
125.00 2,108.80

TWO THOUSAND ONE HUNDRED EIGHT RUPEES AND EIGHTY PAISE ONLY

Swarnadeep Sen
S/O-Dibyendu Sen.
At-204 Samanayan Apartment Tentulberia
Garia St-Road Garja Flat No-204,Ko

700084 Payment Acknowledgement generated through

Online Portal on 15-Jun-20 Time : 19:49:23.
Mobile: 80******27
Email: sw********53@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!