Received With Thanks ' 10,392.70 Through Payment Gateway Over The Internet From

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267277759_1

Collecting Branch : EPS1 Servicing Branch : LIC of India, Agra City Br II 264
LIC OF INDIA,AGRA CITY BR II 264
Transaction No : 2625643
JEEVAN PRAKASH 2ND
Date ( Time ): 24/04/2021 ( 19:01:16 ) M G ROAD,AGRA,0
Email: BO_264@LICINDIA.COM
Receipt No : PR0262564300012122
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 10,392.70 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Poonam Sharma


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) (`) (`) (`)
267277759 814 / 19 10,164.00 1 10,164.00 114.35 264
Poonam Sharma 28/04/2019 YLY 04/21 0.00 114.35 04/22
No 04/21 0.00 10,392.70 09AAACL0582HFZ6
07447264 1,60,000

Page Total (`) 10,164.00 10,164.00 114.35


0.00 114.35
0.00 10,392.70
Grand Total (`) 10,164.00 10,164.00 114.35
0.00 114.35
0.00 10,392.70

TEN THOUSAND THREE HUNDRED NINETY TWO RUPEES AND SEVENTY PAISE ONLY

Poonam Sharma
Consolidated Stamp Duty Paid
W/O Sri Satya Prakash
79 Manas Nagar, CSD/113/2020/1936 DTD. 18.09.2020
Shahganj, Agra , U.P

282010 Payment Acknowledgement generated through


Online Portal on 24-Apr-21 Time : 19:03:17.
Mobile: 97******49
Email: is********ne@gmail.com
For Payment related queries-Email: bo_eps1@licindia.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!

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