Collecting Branch : EPS1 Servicing Branch : LIC of India, Peddapuram Br

D No 19-1-204 Main Road

Transaction No : 13776364
Near Kanyaka Parameshwari
Date ( Time ): 25/09/2019 ( 16:10:54 ) Peddapuram,533437
bo_eps1@licindia.com
Receipt No : PR1377636400011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 17,005.20 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Kommoju R V S V Lakshmi

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.
(`) (`) (`)
805650472 844 16,631.00 1 16,631.00 187.10 69F
Kommoju R V S 16 YLY 09/19 0.00 187.1 09/20
0025169F 06/09/2018 3,00,000 09/19 0.00 17,005.20 0

Page Total (`) 16,631.00 16,631.00 187.10

0.00 187.10
0.00 17,005.20
Grand Total (`) 16,631.00 16,631.00 187.10
0.00 187.10
0.00 17,005.20

SEVENTEEN THOUSAND FIVE RUPEES AND TWENTY PAISE ONLY

Kommoju R V S V Lakshmi
Consolidated Stamp Duty Paid
W/O Kommoju Appalaraju
Flat No T/1 J C Enclave Sarada Colony CSD/328/2019/646/19 DTD.15/02/2019
Anakapalli Visakhapatnam

531001 Payment Acknowledgement generated through

Online Portal on 25-Sep-19 Time : 16:14:37.
Mobile: 9866882976
Email: appalarajukommoju@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!