6/29/2021 https://www.s-commerce.in/Partners/LICPrint.aspx?

type=Print

Collecting Center :Suvidhaa Infoserve Pvt. Ltd. Branch Code: CBK1

Suvidhaa Kiosk Code :RT438642 PCMC, Network Operating Centre,
Receipt No. :3112682 1st Floor, Jeevan Seva Annexe,
S.V.Road, Santacruz(W),
Date (Time) :29/06/2021 11:03:21 AM Mumbai-400054.
Suvidhaa Ref. No. :20119403922062021 Phone: +91-022-1251"
Payment Mode :Cash Email: pcmc.cbk1@licindia.com"

RENEWAL PREMIUM RECEIPT

Received with thanks Rs 1692 through (), Suvidhaa Infoserve Pvt. Ltd. from policy holder
Shri/Smt.'Sh Mahesh Prajapati' towards the following policy/ies

Late Fees
Policy No. Inst.Prem.(Rs) Due Fr No. of Inst. Service Tax
Sr. No. Serv. Brn. Next Due
Short Name Mode Due To Total Prem. (Rs). Ed.Cess
Total Amount
0.0
201194039 1692.0 22/06/2021 1 0.0
1. 35E 22/09/2021
Prajapati M 3 22/06/2021 1692.0 0.00
1692.00
Page total 1692.00
Grand total 1692.00
Rupees One Thousand Six Hundred And Ninety Two Only /-

(Signature of Suvidhaa Kiosk Holder)

Suvidhaa thanks you for using our services.

For any queries please contact Suvidhaa call center at 022-
67159999/9223225225.
1. Suvidhaa is Authorized premium collection agent on behalf of LIC and does not bear any liabilities and consequences
there on arising out of lapse / late payment by policy holder or any other losses.
2. Policyholders are requested to check policy holder name, policy no., date and time of payment and amount before
leaving the payment counter. Suvidhaa shall not receive any complaint for any act/mistake/omission later.
3. Liability for any other act/mistake/omission/commission (if admissible) of Suvidhaa shall be limited up to the premium
amount of disputed policy.
NO SERVICE CHARGES FOR PAYING PREMIUM AT SUVIDHAA POINT.

Suvidhaa Customer Care: +91-9223-225-225

Toll free: 9223225225 / 02267159999
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http://www.mysuvidhaa.com

Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi

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