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

Lic Building M C Road.

Transaction No : 23319782
Chengannur Kerala,
Date ( Time ): 10/10/2020 ( 11:22:45 ) Chengannur,0
Email: bo_eps1@licindia.com
Receipt No : PR2331978200012021
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 17,876.72 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Victor Vijayakumaran Nair

towards the following :

Policy No Plan / Term Inst. Premium No Of Inst Total Premium CGST Branch
Name D.O.C. Mode Due From Late Fee SGST/UTGST Next Due
Revival Sum Assured Due To CD Charges Total Amt Reg. No.
Agency Code
(Yes/No) (`) (`) (`)
396208217 815 / 17 17,462.00 1 17,462.00 196.45 793
Victor V Nair 15/10/2015 QLY 10/20 0.00 218.27 01/21
No 10/20 0.00 17,876.72 32AAACL0582H1ZV
02125793 10,00,000

Page Total (`) 17,462.00 17,462.00 196.45

0.00 218.27
0.00 17,876.72
Grand Total (`) 17,462.00 17,462.00 196.45
0.00 218.27
0.00 17,876.72

SGST includes state cess of 21.82

SEVENTEEN THOUSAND EIGHT HUNDRED SEVENTY SIX RUPEES AND SEVENTY TWO PAISE
ONLY

Victor Vijayakumaran Nair

Consolidated Stamp Duty Paid
Pavithralayam
Thamallakal South CSD/113/2020/1936 DTD. 18.09.2020
Kumarapuram P.O,

690549 Payment Acknowledgement generated through

Online Portal on 10-Oct-20 Time : 11:24:45.
Mobile: 75******14
Email: vi********86@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!