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Collecting Center : A001 Branch Code : 16X

LIC of India, Samana Br Office


Transaction No. : 78963962 LIC OF INDIA,SAMANA BR OFFICE
204-205-206 MALKHANI PATTI
Date ( Time ): 21/12/2021 ( 13:31:08 ) SAMANA, 147101
email: BO_16X@LICINDIA.COM
Call Center No: 022-68276827

RENEWAL PREMIUM RECEIPT

Received with thanks Rs. 3,305.00 from policyholder Shri/Smt.Sh Satish Kumar Singla
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.
162624081 75 3,305.00 1 3,305.00 0.00 16X |0039916X
Satish 20 HLY 12/21 0.00 0.00 06/22
No 28/12/2003 1,01,000.00 12/21 0.00 + 0.00 3,305.00 03AAACL0582H1ZW
Page Total (Rs) 3,305.00 3,305.00 0.00
0.00 0.00
0.00 3,305.00
Grand Total (Rs) 3,305.00 3,305.00 0.00
0.00 0.00
0.00 3,305.00

RUPEES THREE THOUSAND THREE HUNDRED FIVE ONLY


Paid by Cash/Card/Sr :3,305.00
Paid by Cheque :0.00
Cheque No/ChequeDate : 0/

Sh Satish Kumar Singla Consolidated Stamp Duty Paid


S/O Sh Chiranji Lal
Vpo-Hamir Chand,Teh.Sunam,,
Dt.Sangrur. For Life Insurance Corporation of India,
148001. Sh.Suresh Kumar(0018216X)
Mobile:

*SGST also includes cess amount of Rs. 0.00.


GST and Cess borne by LIC of India is Rs 74.36

Har Pal Aapke Sath!!

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