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

Basudebpur Post Khanjanchak.

Transaction No : 9886537
Dist Midnapore,
Date ( Time ): 15/06/2020 ( 19:36:18 ) Haldia,721507
bo_eps1@licindia.com
Receipt No : PR0988653700012021
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 2,095.98 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) (`) (`) (`)
408212003 814 492.00 4 1,968.00 47.29 43A
Swarnadeep 18 MLY 03/20 23.40 47.29 07/20
Yes 13/01/2020 06/20 10.00 2,095.98 19AAACL0582H1ZJ
1,00,000

Page Total (`) 492.00 1,968.00 47.29

23.40 47.29
10.00 2,095.98
Grand Total (`) 492.00 1,968.00 47.29
23.40 47.29
10.00 2,095.98

TWO THOUSAND NINETY FIVE RUPEES AND NINETY EIGHT 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 : 19:49:06.
Mobile: 80******27
Email: sw********53@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!