Collecting Branch : EPS1 Servicing Branch : LIC of India, Branch Unit 120

F-41 [1st Floor]

Transaction No : 21803714
Connaught Place.,Conn.Circus
Date ( Time ): 29/12/2019 ( 13:20:16 ) New Delhi,110001
bo_eps1@licindia.com
Receipt No : PR2180371400011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 12,010.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Anubhav Kathuria

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.
(`) (`) (`)
116807032 165 12,010.00 1 12,010.00 0.00 120
Anubhav 21 YLY 01/20 0.00 0.0 01/21
41409111 03/01/2013 01/20 0.00 12,010.00 07AAACL0582H1ZO
2,50,000

Page Total (`) 12,010.00 12,010.00 0.00

0.00 0.00
0.00 12,010.00
Grand Total (`) 12,010.00 12,010.00 0.00
0.00 0.00
0.00 12,010.00

GST borne by LIC of India ` 270.22

TWELVE THOUSAND TEN RUPEES AND ZERO PAISE ONLY

Anubhav Kathuria
Consolidated Stamp Duty Paid
9 B, Pocket-4,
Mayur Vihar CSD/328/2019/646/19 DTD.15/02/2019
Phase-I, Delhi

110091 Payment Acknowledgement generated through

Online Portal on 29-Dec-19 Time : 13:21:56.
Mobile: 9811653359
Email: lawyer_anubhav@yahoo.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!