Collecting Branch : EPS1 Servicing Branch : 198

E-mail : bo_eps1@licindia.com LIC of India, Bhilwara Br Office I

Phone : +91-022-1251 Jeevan Raksha
Bhopal Ganj Opp Jaswant Talkies.
Transaction No. : PR1169926200011718 Bhilwara Rajasthan
Bhilwara
Date ( Time ): 18/10/2017 ( 10:21:01 ) 311001

RENEWAL PREMIUM ACKNOWLEDGEMENT

Received with thanks Rs. 18761.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Vaibhav Kumar Totla

Towards the following

Policy No Plan Inst. Prem(Rs) No Of Inst Total Premium Tax * Branch

Name Term Mode Due Fr Late Fee Total Amt Next Due
Agency Code D.O.C. Sum Assured Due To CD Charges Reg. No.
188508348 815 18,348.00 1 18,348.00 413.00 198
T Vk 16 HLY 10/17 0.00 18,761.00 04/18
04478198 18/04/2014 5,00,000.00 10/17 0.00
Page Total (Rs) 18,348.00 18,348.00 413.00
0.00 18,761.00
0.00
Grand Total (Rs) 18,348.00 18,348.00 413.00
0.00 18,761.00
0.00

RUPEES EIGHTEEN THOUSAND SEVEN HUNDRED SIXTY-ONE ONLY

Vaibhav Kumar Totla Payment Acknowledgement generated through Online

S/O Gopal Lal Totla,Gopal Bhawan Portal on 18-Oct-2017 Time : 10:29:41.
Near Nilgaro Ki Masjid,Nala Bazar
Bahla,Bhilwara
311001

This receipt is electronically generated.

*Tax here indicates Goods and Services Tax(GST) from 1 July 2017 or Service Tax prior to 1 July 2017.

Har Pal Aap Ke Saath

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