831145243_1

Collecting Branch : EPS1 Servicing Branch : LIC of India, Kendrapara

At/Post-Kendrapara.
Transaction No : 41740535
Dist-Kendrapara (Orissa),
Date ( Time ): 19/03/2021 ( 18:30:01 ) Kendrapara,754211
Email: bo_eps1@licindia.com
Receipt No : PR4174053500012021
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 28,089.10 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Malaya Samal

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) (`) (`) (`)
831145243 836 / 25 27,471.00 1 27,471.00 309.05 504
Malaya Samal 26/09/2018 HLY 03/21 0.00 309.05 09/21
No 03/21 0.00 28,089.10 21AAACL0582H1ZY
02545504 12,00,000

Page Total (`) 27,471.00 27,471.00 309.05

0.00 309.05
0.00 28,089.10
Grand Total (`) 27,471.00 27,471.00 309.05
0.00 309.05
0.00 28,089.10

TWENTY EIGHT THOUSAND EIGHTY NINE RUPEES AND TEN PAISE ONLY

Malaya Samal
Consolidated Stamp Duty Paid
S/O-Prahllad Chandra Samal
At-Manpur Near-Manpur High School, CSD/113/2020/1936 DTD. 18.09.2020
Po-Bhuinpur, Via-Aul,Dt-Kendrapara

754239 Payment Acknowledgement generated through

Online Portal on 19-Mar-21 Time : 18:31:34.
Mobile: 72******81
Email: ma********66@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!