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

LIC OF INDIA,REWARI BRANCH

Transaction No : 28044972
JEEVAN JYOTI, BRASS
Date ( Time ): 08/12/2021 ( 21:13:36 ) HARYANA,123401
Email: BO_11G@LICINDIA.COM
Receipt No : PR2804497200012122
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 26,840.62 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Pawan Kumar

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) (`) (`) (`)
119729680 815 / 21 26,250.00 1 26,250.00 295.31 11G
Pawan Kumar 26/11/2018 HLY 11/21 0.00 295.31 05/22
No 11/21 0.00 26,840.62 06AAACL0582H1ZQ
0238111G 10,00,000

Page Total (`) 26,250.00 26,250.00 295.31

0.00 295.31
0.00 26,840.62
Grand Total (`) 26,250.00 26,250.00 295.31
0.00 295.31
0.00 26,840.62

TWENTY SIX THOUSAND EIGHT HUNDRED FORTY RUPEES AND SIXTY TWO PAISE ONLY

Pawan Kumar
Consolidated Stamp Duty Paid
S/O Sh Subhash Chand
V.P.O.Bagthala CSD/70/2021/2092 DATED - 24.06.2021
Teh.Bawal Dt.Rewari Hr

123501 Payment Acknowledgement generated through

Online Portal on 08-Dec-21 Time : 21:14:42.
Mobile: 87******61
Email: pa********.n@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!