ravi.

avani@gm

666346925_1
Collecting Branch : EPS1 Servicing Branch : LIC of India, Bellary Br Office
LIC OF INDIA,BELLARY BR OFFICE
Transaction No : 8814073
POST BOX NO 29 L I C
Date ( Time ): 15/06/2021 ( 22:59:32 ) KARNATAKA,583101
Email: BO_628@LICINDIA.COM
Receipt No : PR0881407300012122
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 14,914.18 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Ravindra.D.Kulkarni
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) (`) (`) (`)
666346925 815 / 21 14,586.00 1 14,586.00 164.09 628
Ravindra D 28/05/2016 HLY 05/21 0.00 164.09 11/21
No 05/21 0.00 14,914.18 29AAACL0582H2ZH
02462628 5,00,000

Page Total (`) 14,586.00 14,586.00 164.09

0.00 164.09
0.00 14,914.18
Grand Total (`) 14,586.00 14,586.00 164.09
0.00 164.09
0.00 14,914.18

FOURTEEN THOUSAND NINE HUNDRED FOURTEEN RUPEES AND EIGHTEEN PAISE ONLY

Ravindra.D.Kulkarni
S/O Dattatraya Kulkarni , No- 2/18
V V Nagar , Tornagallu
Bellary Dist

583101 Payment Acknowledgement generated through

Online Portal on 30-Jan-22 Time : 21:12:38.
Mobile: 94******37
Email: ra********ni@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!