Collecting Bank: CSC eGovernance Services India Ltd.

Branch Code: CBK1 Branch Code : CSC523521640011

PCMC,Network Operating Center, Reciept No. : 3089503
1st Floor,Jeevan Seva Annexe, Date: 2024-07-01 10:04:59
S.V.Road,Santacruz(W), Mumbai-400054 Ref. No.: LICI2425000095779517
SMS: LICHELP "Policy Number" to 9222492224
CSC Ref. No.: 4183100529518621
Phone: +91-022-1251
Email: bo_cbk1@licindia.com
GSTN: N

RENEWAL PREMIUM RECIEPT

Received With Thanks Rs. 2,901.44 Through CSC EGovernance Services India Ltd. , Retailer ID: 523521640011
Policy Holder: Shri/Smt. Ladu Ram Regar
towards the following policy

CGST Branch
Plan Inst. Premium No. of Inst. Total Premium
Policy No.
SGST/UTGST Next Due
Term Mode Due From Late Fee
Name
Total Amt (Rs) Reg. No.
D.O.C Sum Assured (Rs) Due To CDA Charges
Agency Code

185609575 2,772.00 1 2,772.00 9.87 321

Ladu Ram Regar Yearly 15/02/2024 109.70 9.87 15/02/2025

15/02/2024 0.00 19.74 08AAACL0582H2ZL

2,772.00 9.87
Page Total (Rs) 2,772.00 109.70 9.87
0.00 19.74

2,772.00 9.87
Grand Total (Rs) 2,772.00 109.70 9.87
0.00 19.74

In Words (Rupees) : Two Thousand, Nine Hundred One Rupees And Forty Four Paise

Retailer Signature
Retailer ID : 523521640011
Bhagchand Sharma

LIC PREMIUM PAYMENT FACILITY IS FREE OF COST. POLICY HOLDERS NEED NOT TO PAY ANY EXTRA AMOUNT AS SERVICE CHARGE OF
RETAILER/FRANCHISEES

Retailer : CSC e-Governanace Services India Ltd. 238, Okhla Industrial State, Phase-III, New Delhi-110020
Computer generated receipt. Receipt validity subject to payment realization.
PRINTED ON | 01-07-2024 10:05:02