r.

barik003@g

846748314_1
Collecting Branch : EPS1 Servicing Branch : LIC of India, Dhenkanal Branch
LIC OF INDIA,DHENKANAL BRANCH
Transaction No : 1265715
P O DHENKANAL.,DT DHENKANAL
Date ( Time ): 10/04/2024 ( 08:08:52 ) ,759001
Email: BO_582@LICINDIA.COM
Receipt No : PR0126571500012425
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 5,967.32 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Chitta Ranjan Barik

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) (`) (`)
846748314 821 / 25 5,836.00 1 5,836.00 65.66 582
Chitta Ranjan 28/03/2017 YLY 03/24 0.00 65.66 03/25
No 03/24 0.00 5,967.32 21AAACL0582H1ZY
03488582 1,00,000

Page Total (`) 5,836.00 5,836.00 65.66

0.00 65.66
0.00 5,967.32
Grand Total (`) 5,836.00 5,836.00 65.66
0.00 65.66
0.00 5,967.32

FIVE THOUSAND NINE HUNDRED SIXTY SEVEN RUPEES AND THIRTY TWO PAISE ONLY

Chitta Ranjan Barik

Consolidated Stamp Duty Paid
S/O-Krushna Chandra Barik
At/Po-Damodarpur LOA/CSD/16/2023/4476 dtd 06/11/2023 valid from 10/11/2023 to
Via-Sukinda,Dist-Jajpur

755018 Payment Acknowledgement generated through

Online Portal on 10-Apr-24 Time : 08:14:40.
Mobile: 78******64
Email: r.********03@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!