683630867_1

Collecting Branch : EPS1 Servicing Branch : LIC of India, Husnabad Br

LIC OF INDIA
Transaction No : 22852850
NAGARAM ROAD,HUSNABAD
Date ( Time ): 15/10/2021 ( 18:55:44 ) ,505467
Email: BO_6151@LICINDIA.COM
Receipt No : PR2285285000012122
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 1,243.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Cheekoti Madhav, S/O Ch. Agaiah

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) (`) (`) (`)
683630867 121 / 25 1,243.00 1 1,243.00 0.00 6151
Cheekoti 15/10/2003 HLY 10/21 0.00 0.00 04/22
No 10/21 0.00 1,243.00 36AAACL0582H1ZN
002216151 50,000.00

Page Total (`) 1,243.00 1,243.00 0.00

0.00 0.00
0.00 1,243.00
Grand Total (`) 1,243.00 1,243.00 0.00
0.00 0.00
0.00 1,243.00

GST borne by LIC of India ` 27.96

ONE THOUSAND TWO HUNDRED FORTY THREE RUPEES AND ZERO PAISE ONLY

Cheekoti Madhav, S/O Ch. Agaiah

Teacher, Post Thotapally
Mdl Husanabad
Dist Karimnagar

505466 Payment Acknowledgement generated through

Online Portal on 15-Oct-21 Time : 18:59:14.
Mobile: 70******49
Email: hr********18@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!