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

LIC OF INDIA,MANDYA BRANCH

Transaction No : 1123186
BANDIGOWDA LAY
Date ( Time ): 10/04/2021 ( 14:26:09 ) ,571401
Email: BO_618@LICINDIA.COM
Receipt No : PR0112318600012122
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 961.16 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Suhash.H.R
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) (`) (`) (`)
726827997 836 / 21 940.00 1 940.00 10.58 618
Suhash.H.R 28/01/2018 MLY 04/21 0.00 10.58 05/21
No 04/21 0.00 961.16 29AAACL0582H2ZH
0049872D 2,00,000

Page Total (`) 940.00 940.00 10.58

0.00 10.58
0.00 961.16
Grand Total (`) 940.00 940.00 10.58
0.00 10.58
0.00 961.16

NINE HUNDRED SIXTY ONE RUPEES AND SIXTEEN PAISE ONLY

Suhash.H.R
S/O Renukumar.H.C, 19
Nalwadikrishnaraja Badavane,Kaluwe Road
Kiragandur,Mandya

571403 Payment Acknowledgement generated through

Online Portal on 10-Apr-21 Time : 14:30:44.
Mobile: 97******16
Email: su********85@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!