Renewal Premium Receipt: This Receipt Is Subject To Realisation of Cheque Amount

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Collecting Center : A001 Branch Code : 701

LIC of India, R S Puram Br Office


Transaction No. : 35796390 LIC OF INDIA,R S PURAM BR OFFICE
2ND FLOOR OBLI TOWERS,P B NO-1162
Date ( Time ): 12/07/2021 ( 16:07:05 ) COIMBATORE (TN), 641002
email: BO_701@LICINDIA.COM
Call Center No: 022-68276827

RENEWAL PREMIUM RECEIPT

Received with thanks Rs. 5,157.00 from policyholder Shri/Smt.Sri Arun Kumar T
towards the following policy/ies

Policy No Plan Inst. Prem(Rs) No Of Inst Total Premium CGST Branch | Agency
Name Term Mode Due Fr Late Fee SGST*/UTGST Code
Revival D.O.C. Sum Assured Due To CD Chgs + Total Amt Next Due
(Yes/No) Xcharge Reg. No.
751742346 93 5,157.00 1 5,157.00 0.00 701 |03264745
Arun Kumar T 25 YLY 07/21 0.00 0.00 No Due
No 14/07/1997 1,00,000.00 07/21 0.00 + 0.00 5,157.00 33AAACL0582H1ZT
Page Total (Rs) 5,157.00 5,157.00 0.00
0.00 0.00
0.00 5,157.00
Grand Total (Rs) 5,157.00 5,157.00 0.00
0.00 0.00
0.00 5,157.00

RUPEES FIVE THOUSAND ONE HUNDRED FIFTY-SEVEN ONLY


Paid by Cash/Card/Sr :0.00
Paid by Cheque :5,157.00
Cheque No/ChequeDate : 130/12/07/2021

Sri Arun Kumar T Consolidated Stamp Duty Paid


1/419,Krishnamurthy Iyer Street, CSD/70/2021/2092 DATED - 24.06.2021
Ng G Ocolony,
Coimbatore
641022. For Life Insurance Corporation of India,
Mobile: C.Sivasamy,(00678704)

*SGST also includes cess amount of Rs. 0.00.


GST and Cess borne by LIC of India is Rs 116.04
This receipt is subject to realisation of cheque amount.

Har Pal Aapke Sath!!

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