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

42/A Impression House,

Transaction No : 18286928
G. D. Ambekar Marg, ,Near Ram
Date ( Time ): 18/11/2019 ( 22:36:27 ) Mumbai,400032
bo_eps1@licindia.com
Receipt No : PR1828692800011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 33,307.94 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Shashank Chanrahas Raikar

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.
(`) (`) (`)
912664192 815 32,575.00 1 32,575.00 366.47 88H
Shashank 25 YLY 11/19 0.00 366.47 11/20
0172488H 28/11/2018 7,50,000 11/19 0.00 33,307.94 0

Page Total (`) 32,575.00 32,575.00 366.47

0.00 366.47
0.00 33,307.94
Grand Total (`) 32,575.00 32,575.00 366.47
0.00 366.47
0.00 33,307.94

THIRTY THREE THOUSAND THREE HUNDRED SEVEN RUPEES AND NINETY FOUR PAISE ONLY

Shashank Chanrahas Raikar

Consolidated Stamp Duty Paid
C/310,Pushp Darshan Soc,
Gaondevi Chowk Shastri Ngr CSD/328/2019/646/19 DTD.15/02/2019
Dombivali East , Thane.

421202 Payment Acknowledgement generated through

Online Portal on 18-Nov-19 Time : 22:38:27.
Mobile: 8850082032
Email: shashank.c.raikar@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!