info.

praveenku
mar89@gmail.

126325137_1
Collecting Branch : EPS1 Servicing Branch : LIC of India, Rohini Branch
LIC OF INDIA, BRANCH UNIT 12T
Transaction No : 11688458
SACHDEVA CORPORATE TOWER,
Date ( Time ): 21/07/2023 ( 09:45:30 ) ROHINI,DELHI,110085
Email: BO_12T@LICINDIA.COM
Receipt No : PR1168845800012324
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 10,204.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : P
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) (`) (`) (`)
126325137 149 / 78 10,204.00 1 10,204.00 0.00 12T
Parveen Kumar 28/07/2011 YLY 07/23 0.00 0.00 07/24
No 07/23 0.00 10,204.00 07AAACL0582H1ZO
0105312T 2,00,000

Page Total (`) 10,204.00 10,204.00 0.00

0.00 0.00
0.00 10,204.00
Grand Total (`) 10,204.00 10,204.00 0.00
0.00 0.00
0.00 10,204.00

GST borne by LIC of India ` 229.60

TEN THOUSAND TWO HUNDRED FOUR RUPEES AND ZERO PAISE ONLY

P
Consolidated Stamp Duty Paid
Hno 34,Gali No 1
Mohan Nagar, LOA/CSD/48/2023/2582 DATED 22.05.2023 for Rs 3 Cr Valid
Samaypur,Delhi

110042 Payment Acknowledgement generated through

Online Portal on 21-Jul-23 Time : 09:47:59.
Mobile: 85******07
Email: in********89@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!