Servicing Branch : 687

TENALI
LIC OF INDIA,TENALI BRANCH OFFICE
P B NO 21 DOOR NO 22-6-46
KRISHNA RAO NAIDU STREET
Collecting Branch : PCMC KOTHAPET.
Call Center (24X7) : 022 6827 6827 TENALI DT GUNTUR A P
Transaction no. : 7198749 PIN:522201 Phone:
Date : 31/01/2022 Email: bo_687@licindia.com

RENEWAL PREMIUM ACKNOWLEDGEMENT

through EBPP (Bill-

Received with thanks Rs. 14412.00 pay)
from Smt/Shri/Ms R.PRASAD
towards the following
Policy Number 677120624 Premium Due From 1/2022
Instalment Premium 14412.00 Premium Due Upto 1/2022
Premium Mode Yearly No. of Instalments 1
Plan, Term & PPT 165/15/15 Premium 14412.00
Date of Commence. 28/01/2012 Late Fee 0.00
Sum Assured 300000 CGST/SGST/UTGST 0.00
Next Premium Due on 28/01/2023
GST Borne By LIC 324.28 Total 14412.00

MUNAGALA RAMA PRASAD

S/O SIVA KOTESWARA RAO
D.NO.12-20,OPP.POST OFFICE
KOLLIPARA P.O & MDL GUNTUR DT.
PIN Code: 500000

This receipt is electronically generated

Mudrank: CSD/70/2021/2092

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Har Pal Aapke Saath