Collecting Branch : EPS1 Servicing Branch : LIC of India, Coimbatore North

108-109 Nsr Road P B No-2740

Transaction No : 18170451
S B Mission Post.,Coimbatore
Date ( Time ): 27/08/2020 ( 15:28:05 ) Coimbatore,641011
bo_eps1@licindia.com
Receipt No : PR1817045100012021
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 2,450.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Selvaraj P
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
Revival D.O.C. Sum Assured Due To CD Charges Total Amt Reg. No.
(Yes/No) (`) (`) (`)
763183099 165 2,450.00 1 2,450.00 0.00 805
P.Selvaraj 16 QLY 08/20 0.00 0.00 11/20
No 21/05/2012 08/20 0.00 2,450.00 33AAACL0582H1ZT
2,00,000

Page Total (`) 2,450.00 2,450.00 0.00

0.00 0.00
0.00 2,450.00
Grand Total (`) 2,450.00 2,450.00 0.00
0.00 0.00
0.00 2,450.00

GST borne by LIC of India ` 55.12

TWO THOUSAND FOUR HUNDRED FIFTY RUPEES AND ZERO PAISE ONLY

Selvaraj P
D.No-1/13,
Paruvai,
Palladam Via.

641658 Payment Acknowledgement generated through

Online Portal on 27-Aug-20 Time : 15:29:54.
Mobile: 96******48
Email: vi********aj@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!