swathiv659@g

We observe

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

LIC OF INDIA,BHADRACHALAM
Transaction No : 40601635
GOVT HOSPITAL
Date ( Time ): 20/03/2022 ( 17:15:26 ) DT KHAMMAM A P,507111
Email: BO_64R@LICINDIA.COM
Receipt No : PR4060163500012122
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 11,267.96 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Nllamothu Swathi

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) (`) (`) (`)
613724237 836 / 21 11,020.00 1 11,020.00 123.98 64R
Nllamothu 28/03/2019 YLY 03/22 0.00 123.98 03/23
No 03/22 0.00 11,267.96 36AAACL0582H1ZN
0172264R 2,00,000

Page Total (`) 11,020.00 11,020.00 123.98

0.00 123.98
0.00 11,267.96
Grand Total (`) 11,020.00 11,020.00 123.98
0.00 123.98
0.00 11,267.96

ELEVEN THOUSAND TWO HUNDRED SIXTY SEVEN RUPEES AND NINETY SIX PAISE ONLY

Nllamothu Swathi
Consolidated Stamp Duty Paid
D/O Venkateswarlu
H.No 5-1-87/1,Kaviraj Nagar,Kanapuram, CSD/70/2021/2092 DATED - 24.06.2021
Haweli,Khammam

507002 Payment Acknowledgement generated through

Online Portal on 20-Mar-22 Time : 17:17:02.
Mobile: 76******40
Email: sw********59@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!