We observe

Collecting Branch : EPS1 Servicing Branch : LIC of India, Chennai City Br

LIC OF INDIA,CHENNAI CITY BR
Transaction No : 7012879
37,1ST MAIN ROAD,GANDHI NAGAR
Date ( Time ): 31/05/2021 ( 17:41:02 ) CHENNAI,600020
Email: BO_71M@LICINDIA.COM
Receipt No : PR0701287900012122
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 619.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Sri.M. Rajendran

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) (`) (`) (`)
717939493 14 / 21 619.00 1 619.00 0.00 71M
Sri.M. Rajendran 28/05/2006 QLY 05/21 0.00 0.00 08/21
No 05/21 0.00 619.00 33AAACL0582H1ZT
02120697 50,000.00

Page Total (`) 619.00 619.00 0.00

0.00 0.00
0.00 619.00
Grand Total (`) 619.00 619.00 0.00
0.00 0.00
0.00 619.00

GST borne by LIC of India ` 13.92

SIX HUNDRED NINETEEN RUPEES AND ZERO PAISE ONLY

Sri.M. Rajendran
C/O Friends Tea Shop,
No-33, 3rd Cross Street,Kasturba Nagar,
Adyar,, Chennai

600020 Payment Acknowledgement generated through

Online Portal on 31-May-21 Time : 17:42:43.
Mobile: 98******37
Email: ve********12@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!