mitisha.

manjre
kar@gmail.co

906206398_1
Collecting Branch : EPS1 Servicing Branch : LIC of India, Mumbai B O 915
LIC OF INDIA,BOMBAY B O 915
Transaction No : 20346581
JEEVAN PRAKASH 2ND FLR,FORT
Date ( Time ): 30/09/2022 ( 20:48:25 ) MUMBAI,400001
Email: BO_915@LICINDIA.COM
Receipt No : PR2034658100022223
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 1,036.23 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Mitisha Eknath Hirlekar

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) (`) (`) (`)
906206398 165 / 25 510.00 2 1,020.00 1.24 915
Mitisha Eknath 28/02/2010 MLY 08/22 3.75 1.24 10/22
Yes 09/22 10.00 1,036.23 27AAACL0582H1ZM
00382915 1,25,000

Page Total (`) 510.00 1,020.00 1.24

3.75 1.24
10.00 1,036.23
Grand Total (`) 510.00 1,020.00 1.24
3.75 1.24
10.00 1,036.23

GST borne by LIC of India ` 22.96 Late Fee Waived : ` 1.25

ONE THOUSAND THIRTY SIX RUPEES AND TWENTY THREE PAISE ONLY

Mitisha Eknath Hirlekar

Shridarshan Chs,Set-9/B-9/301
Shanti Nagar,Mira Road E
Dist-Thane

401107 Payment Acknowledgement generated through

Online Portal on 30-Sep-22 Time : 20:50:57.
Mobile: 99******64
Email: mi********ar@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!

 mitisha.manjre
kar@gmail.co

906206397_2
Collecting Branch : EPS1 Servicing Branch : LIC of India, Mumbai B O 915
LIC OF INDIA,BOMBAY B O 915
Transaction No : 20346581
JEEVAN PRAKASH 2ND FLR,FORT
Date ( Time ): 30/09/2022 ( 20:48:25 ) MUMBAI,400001
Email: BO_915@LICINDIA.COM
Receipt No : PR2034658100022223
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 1,171.93 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Mitisha Eknath Hirlekar

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) (`) (`) (`)
906206397 165 / 25 510.00 2 1,020.00 11.59 915
Mitisha Eknath 28/02/2010 MLY 08/22 3.75 11.59 10/22
Yes 09/22 125.00 1,171.93 27AAACL0582H1ZM
00382915 1,25,000

Page Total (`) 510.00 1,020.00 11.59

3.75 11.59
125.00 1,171.93
Grand Total (`) 510.00 1,020.00 11.59
3.75 11.59
125.00 1,171.93

GST borne by LIC of India ` 22.96 Late Fee Waived : ` 1.25

ONE THOUSAND ONE HUNDRED SEVENTY ONE RUPEES AND NINETY THREE PAISE ONLY

Mitisha Eknath Hirlekar

Shridarshan Chs,Set-9/B-9/301
Shanti Nagar,Mira Road E
Dist-Thane

401107 Payment Acknowledgement generated through

Online Portal on 30-Sep-22 Time : 20:50:57.
Mobile: 99******64
Email: mi********ar@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!