188508348_1

Collecting Branch : EPS1 Servicing Branch : LIC of India, Bhilwara Br Office

LIC OF INDIA,BHILWARA BR OFFICE I
Transaction No : 25154602
JEEVAN RAKSHA,BHOPAL GANJ
Date ( Time ): 09/11/2021 ( 18:01:49 ) BHILWARA RAJASTHAN,311001
Email: BO_198@LICINDIA.COM
Receipt No : PR2515460200012122
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 18,760.84 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Vaibhav Kumar Totla

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) (`) (`) (`)
188508348 815 / 16 18,348.00 1 18,348.00 206.42 198
Vaibhav Kumar 18/04/2014 HLY 10/21 0.00 206.42 04/22
No 10/21 0.00 18,760.84 08AAACL0582H2ZL
04478198 5,00,000

Page Total (`) 18,348.00 18,348.00 206.42

0.00 206.42
0.00 18,760.84
Grand Total (`) 18,348.00 18,348.00 206.42
0.00 206.42
0.00 18,760.84

EIGHTEEN THOUSAND SEVEN HUNDRED SIXTY RUPEES AND EIGHTY FOUR PAISE ONLY

Vaibhav Kumar Totla

Consolidated Stamp Duty Paid
S/O Gopal Lal Totla,Gopal Bhawan
Near Nilgaro Ki Masjid,Nala Bazar CSD/70/2021/2092 DATED - 24.06.2021
Bahla,Bhilwara

311001 Payment Acknowledgement generated through

Online Portal on 09-Nov-21 Time : 18:05:46.
Mobile: 98******80
Email: ca********la@yahoo.in
For Payment related queries-Email: bo_eps1@licindia.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!