Collecting Branch : EPS1 Servicing Branch : 687

E-mail : bo_eps1@licindia.com LIC of India, Tenali Branch Office

Phone : +91-022-1251 P B No 21 Door No 22-6-46
Krishna Rao Naidu Street Kothapet.
Transaction No. : PR0401417200031718 Tenali Dt Guntur A P
Tenali
Date ( Time ): 30/06/2017 ( 23:30:46 ) 522201

RENEWAL PREMIUM RECEIPT

Received with thanks Rs. 4980.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Mahanty Sunil Kumar

Towards the following

Policy No Plan Inst. Prem(Rs) No Of Inst Total Premium Service Tax Branch
Name Term Mode Due Fr Late Fee Edu Cess Next Due
Agency Code D.O.C. Sum Assured Due To CD Charges Total Amt
677143113 93 1,360.00 1 1,360.00 0.00 687
S Kumar M 25 HLY 07/17 0.00 0.00 01/18
03381687 11/07/2013 50,000.00 07/17 0.00 1,360.00
677143114 149 1,711.00 1 1,711.00 0.00 687
S Kumar M 74 HLY 07/17 0.00 0.00 01/18
03381687 11/07/2013 1,00,000.00 07/17 0.00 1,711.00
677143284 179 1,909.00 1 1,909.00 0.00 687
S Kumar M 20 HLY 07/17 0.00 0.00 01/18
03381687 15/07/2013 1,00,000.00 07/17 0.00 1,909.00
Page Total (Rs) 4,980.00 4,980.00 0.00
0.00 0.00
0.00 4,980.00
Grand Total (Rs) 4,980.00 4,980.00 0.00
0.00 0.00
0.00 4,980.00

RUPEES FOUR THOUSAND NINE HUNDRED EIGHTY ONLY

Mahanty Sunil Kumar

S/O M Trilochan,D.No B-1/3,
Hsl Quarters Scindia P.O
Gandhigram, Visakhapatnam
530005

This receipt is electronically generated.

Har Pal Aap Ke Saath

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