jambunathanm

v@yahoo.co.in

614065796_1
Collecting Branch : EPS1 Servicing Branch : LIC of India, Bangalore City
LIC OF INDIA,BANGALORE CITY
Transaction No : 40005583
I FLOOR, UNITED INDIA BUILDING,,J
Date ( Time ): 15/03/2023 ( 20:18:19 ) BANGALORE,560002
Email: BO_611@LICINDIA.COM
Receipt No : PR4000558300012223
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 3,617.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : M V Jambunathan
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) (`) (`) (`)
614065796 75 / 20 3,617.00 1 3,617.00 0.00 611
MV 28/03/2005 YLY 03/23 0.00 0.00 03/24
No 03/23 0.00 3,617.00 29AAACL0582H2ZH
06497611 50,000.00

Page Total (`) 3,617.00 3,617.00 0.00

0.00 0.00
0.00 3,617.00
Grand Total (`) 3,617.00 3,617.00 0.00
0.00 0.00
0.00 3,617.00

GST borne by LIC of India ` 81.38

THREE THOUSAND SIX HUNDRED SEVENTEEN RUPEES AND ZERO PAISE ONLY

M V Jambunathan
No.202/B, J J Apartments,
38th Main, J P Nagar 6th Phase
Bangalore.

560078 Payment Acknowledgement generated through

Online Portal on 15-Mar-23 Time : 20:20:51.
Mobile: 87******65
Email: ja********mv@yahoo.co.in
For Payment related queries-Email: bo_eps1@licindia.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!