258003793_1

Collecting Branch : EPS1 Servicing Branch : LIC of India, Ghaziabad

LIC OF INDIA,CBO-II
Transaction No : 13645251
BRANCH CODE 25H,408/2,MODEL
Date ( Time ): 30/07/2021 ( 23:19:28 ) GHAZIABAD (UP),201001
Email: BO_25H@LICINDIA.COM
Receipt No : PR1364525100012122
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 4,034.78 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Navneesh Agarwal

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) (`) (`) (`)
258003793 814 / 26 3,946.00 1 3,946.00 44.39 25H
Navneesh 28/07/2014 YLY 07/21 0.00 44.39 07/22
No 07/21 0.00 4,034.78 09AAACL0582HFZ6
0183925H 1,00,000

Page Total (`) 3,946.00 3,946.00 44.39

0.00 44.39
0.00 4,034.78
Grand Total (`) 3,946.00 3,946.00 44.39
0.00 44.39
0.00 4,034.78

FOUR THOUSAND THIRTY FOUR RUPEES AND SEVENTY EIGHT PAISE ONLY

Navneesh Agarwal
Ke-112 Kavi Nagar
Ghaziabad Up

201002 Payment Acknowledgement generated through

Online Portal on 30-Jul-21 Time : 23:21:32.
Mobile: 98******48
Email: nf********ly@rediffmail.com
For Payment related queries-Email: bo_eps1@licindia.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!