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

No 148 Opp Govt. Junior College

Transaction No : 19006366
B H Road,Tiptur
Date ( Time ): 03/09/2020 ( 22:09:54 ) Tiptur,572201
Email: bo_eps1@licindia.com
Receipt No : PR1900636600012021
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 17,774.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : H.R.Ravikiran
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) (`) (`) (`)
617082926 149 / 74 17,774.00 1 17,774.00 0.00 605
H.R.Ravikiran 28/03/2013 HLY 09/20 0.00 0.00 03/21
No 09/20 0.00 17,774.00 29AAACL0582H2ZH
02377605 5,00,000

Page Total (`) 17,774.00 17,774.00 0.00

0.00 0.00
0.00 17,774.00
Grand Total (`) 17,774.00 17,774.00 0.00
0.00 0.00
0.00 17,774.00

GST borne by LIC of India ` 399.92

SEVENTEEN THOUSAND SEVEN HUNDRED SEVENTY FOUR RUPEES AND ZERO PAISE ONLY

H.R.Ravikiran
S/O H.K.Ramesh. Lecturer.
Handanakere Post. C.N.Halli Tq
Tumkur Dist

572119 Payment Acknowledgement generated through

Online Portal on 09-Jan-21 Time : 14:14:17.
Mobile: 77******68
Email: ra********hd@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!