Collecting Branch : EPS1 Servicing Branch : LIC of India, Hyderabad City

16-2-677/2 and 2/1 II and III floors

Transaction No : 12058522
judges colony,Malakpet,Hyderabad
Date ( Time ): 05/09/2019 ( 19:06:38 ) Hyderabad,500036
bo_eps1@licindia.com
Receipt No : PR1205852200011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 24,020.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Santhosh Dhoopati

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.
(`) (`) (`)
647813988 165 24,020.00 1 24,020.00 0.00 64K
Dhoopati 25 YLY 09/19 0.00 0.0 09/20
0155564K 13/09/2010 5,00,000 09/19 0.00 24,020.00 0

Page Total (`) 24,020.00 24,020.00 0.00

0.00 0.00
0.00 24,020.00
Grand Total (`) 24,020.00 24,020.00 0.00
0.00 0.00
0.00 24,020.00

GST borne by LIC of India ` 540.46

TWENTY FOUR THOUSAND TWENTY RUPEES AND ZERO PAISE ONLY

Santhosh Dhoopati
Consolidated Stamp Duty Paid
Hno.17-18,Flat No.304
Srinagar Colony,Dilsukhnagar CSD/328/2019/646/19 DTD.15/02/2019
Hyderabad

500060 Payment Acknowledgement generated through

Online Portal on 05-Sep-19 Time : 19:08:44.
Mobile: 9618167678
Email: sdhoopati@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!