ajayjain2469@

203638381_1
Collecting Branch : EPS1 Servicing Branch : LIC of India, Shivpuri Br Office
LIC OF INDIA,SHIVPURI BRANCH
Transaction No : 6560820
HAZI SANNU MARKET,A.B.ROAD
Date ( Time ): 22/05/2024 ( 20:26:23 ) SHIVPURI M P,473551
Email: BO_34B@LICINDIA.COM
Receipt No : PR0656082000012425
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 19,185.16 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Vimla Jain

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) (`) (`)
203638381 836 / 16 18,763.00 1 18,763.00 211.08 34B
Vimla Jain 28/05/2017 YLY 05/24 0.00 211.08 05/25
No 05/24 0.00 19,185.16 23AAACL0582H2ZT
0079734B 2,00,000

Page Total (`) 18,763.00 18,763.00 211.08

0.00 211.08
0.00 19,185.16
Grand Total (`) 18,763.00 18,763.00 211.08
0.00 211.08
0.00 19,185.16

NINETEEN THOUSAND ONE HUNDRED EIGHTY FIVE RUPEES AND SIXTEEN PAISE ONLY

Vimla Jain
Consolidated Stamp Duty Paid
W/O Sri Surash Chand Jain
Block Office Ke Samne Main Road LOA/CSD/16/2023/4476 dtd 06/11/2023 valid from 10/11/2023 to
Bhitarwar ,Dt-Gwalior Mp

475220 Payment Acknowledgement generated through

Online Portal on 22-May-24 Time : 20:28:17.
Mobile: 99******40
Email: aj********69@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!