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

41 Baghajatin Road Baranagar.

Transaction No : 10488397
Calcutta,
Date ( Time ): 21/06/2020 ( 14:50:12 ) Baranagar,700036
bo_eps1@licindia.com
Receipt No : PR1048839700012021
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 3,136.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Dibyendu Mukherjee

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) (`) (`) (`)
423723809 75 3,136.00 1 3,136.00 0.00 430
Dibyendu 20 YLY 06/20 0.00 0.00 06/21
No 20/06/2003 06/20 0.00 3,136.00 19AAACL0582H1ZJ
50,000.00

Page Total (`) 3,136.00 3,136.00 0.00

0.00 0.00
0.00 3,136.00
Grand Total (`) 3,136.00 3,136.00 0.00
0.00 0.00
0.00 3,136.00

GST borne by LIC of India ` 70.56

THREE THOUSAND ONE HUNDRED THIRTY SIX RUPEES AND ZERO PAISE ONLY

Dibyendu Mukherjee
C/O Mihir Mukherjee
Vill-Gopinath Dihi Po-Dhaban,
Dist Bankura

722137 Payment Acknowledgement generated through

Online Portal on 21-Jun-20 Time : 14:52:57.
Mobile: 96******55
Email: sa********me@yahoo.co.in

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!