Collecting Branch : EPS1 Servicing Branch : LIC of India, Sirkazhibr Office

77 North Car Street

Transaction No : 8068181
Sirkazhi,Nagapattinam Dt.
Date ( Time ): 01/08/2018 ( 13:11:29 ) Sirkali,609110
bo_eps1@licindia.com
Receipt No : PR0806818100011819
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 10,168.49 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Shafiq Ahamed

towards the following :

Policy No Plan Inst. Premium No Of Inst Total Premium CGST Branch

Name Term Mode Due From Late Fee SGST/UTGST Next Due
Agency Code D.O.C. Sum Assured Due To CD Charges Total Amt Reg. No.
(`) (`) (`)
756039750 91 9,982.00 1 9,982.00 14.22 7226
I Shafiq Ahamed 20 HLY 05/18 158.05 14.22 11/18
002627226 27/05/2011 4,00,000 05/18 0.00 10,168.49

Page Total (`) 9,982.00 9,982.00 14.22

158.05 14.22
0.00 10,168.49
Grand Total (`) 9,982.00 9,982.00 14.22
158.05 14.22
0.00 10,168.49

GST borne by LIC of India ` 224.60

TEN THOUSAND ONE HUNDRED SIXTY EIGHT RUPEES AND FORTY NINE PAISE ONLY

Shafiq Ahamed
Consolidated Stamp Duty Paid
S/O Mohamed Ibrahim
1/1 Samiyam Road,Thulasendirapuram CSD/64/2018/2366/18 dtd. 26/06/2018
Kollidam-Po,Sirkali-Tk

609102 Payment Acknowledgement generated through

Online Portal on 01-Aug-18 Time : 13:15:58.
Mobile: 7339644914
Email: shaafiqahamed@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!