vijayaragha@g

Collecting Branch : EPS1 Servicing Branch : LIC of India, Bangalore Cb 6

LIC OF INDIA,BANGALORE CB 6 (KG
Transaction No : 17610660
PRITHVI BUILDING,K G ROAD.
Date ( Time ): 06/09/2022 ( 14:43:45 ) BANGALORE,560009
Email: BO_604@LICINDIA.COM
Receipt No : PR1761066000012223
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks Rs.50,210.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Vikas H.A

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) (Rs)
(Rs) (Rs)
616017076 178 / 81 50,210.00 1 50,210.00 0.00 604
Vikas H.A 23/09/2009 YLY 09/22 0.00 0.00 09/23
02185604 09/22 0.00 50,210.00 29AAACL0582H2ZH
No 5,00,000

Page Total 50210.00 50,210.00 0.00

(`) 0.00 0.00
0.00 50,210.00

50,210.00 50,210.00 0.00

Grand Total 0.00 0.00
(`)
0.00 50,210.00

GST borne by LIC of India Rs.553.72

FIFTY THOUSAND TWO HUNDRED AND TEN RUPEES AND ZERO PAISE ONLY

Vikas H.A
Consolidated Stamp Duty Paid
S/O Appaji Gowda.R
LOA NO/CSD/390/2022 Dtd - 28.06.2022
Halasinahally, Kadaga(P)
Salagame (H), Hassan (TQ & Dist)

Pin-573201 Payment Acknowledgement generated through

Online Portal on 06-Sep-22 Time : 14:47:13.
Mobile: 99******40
Email: vi********ha@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!