Received With Thanks ' 7,690.00 Through Payment Gateway Over The Internet From

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Collecting Branch : EPS1 Servicing Branch : LIC of India, Shrirampur Br

Shivaji Road
Transaction No : 33563849
1071 Dudhedia Building P B No
Date ( Time ): 10/01/2021 ( 16:46:12 ) Shrirampur,413709
Email: [email protected]
Receipt No : PR3356384900012021
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 7,690.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Chaudhari P A
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) (`) (`) (`)
953970733 152 / 74 7,690.00 1 7,690.00 0.00 959
Pradeep 28/01/2004 YLY 01/21 0.00 0.00 01/22
No 01/21 0.00 7,690.00 27AAACL0582H1ZM
01718959 2,00,000

Page Total (`) 7,690.00 7,690.00 0.00


0.00 0.00
0.00 7,690.00
Grand Total (`) 7,690.00 7,690.00 0.00
0.00 0.00
0.00 7,690.00

GST borne by LIC of India ` 173.02


SEVEN THOUSAND SIX HUNDRED NINETY RUPEES AND ZERO PAISE ONLY

Chaudhari P A
Consolidated Stamp Duty Paid
C/O-Ambadas Ramdas Chaudhari
Kinhi, CSD/113/2020/1936 DTD. 18.09.2020
Tal-Bhusawal,Dist-Jalgaon.

999999 Payment Acknowledgement generated through


Online Portal on 10-Jan-21 Time : 16:50:16.
Mobile: 90******05
Email: ap********[email protected]

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!

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