harish.

singh@
cypressgreen.i

334281603_1
Collecting Branch : EPS1 Servicing Branch : LIC of India, Sukrali Ranch
LIC OF INDIA,SUKRALI BRANCH
Transaction No : 415424
7TH FLOOR, PALMCOURT
Date ( Time ): 04/04/2023 ( 11:12:46 ) GURGAON.,122001
Email: BO_12M@LICINDIA.COM
Receipt No : PR0041542400012324
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 5,398.80 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Harish Singh

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) (`) (`) (`)
334281603 814 / 15 5,280.00 1 5,280.00 59.40 12M
Harish Singh 11/09/2015 QLY 03/23 0.00 59.40 06/23
No 03/23 0.00 5,398.80 06AAACL0582H1ZQ
0227912M 3,00,000

Page Total (`) 5,280.00 5,280.00 59.40

0.00 59.40
0.00 5,398.80
Grand Total (`) 5,280.00 5,280.00 59.40
0.00 59.40
0.00 5,398.80

FIVE THOUSAND THREE HUNDRED NINETY EIGHT RUPEES AND EIGHTY PAISE ONLY

Harish Singh
Consolidated Stamp Duty Paid
H No.-6,Betuliya
Almora,Po-Dist. Almora LOA/CSD/526/4822 DTD- 14.11.2022 valid from 16.12.2022 to
Uttarakhand

263681 Payment Acknowledgement generated through

Online Portal on 04-Apr-23 Time : 11:14:10.
Mobile: 96******87
Email: ha********gh@cypressgreen.in
For Payment related queries-Email: bo_eps1@licindia.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!