Collecting Branch : EPS1 E-mail : bo_eps1@licindia.com Phone : +91-022-1251 Transaction No.

: PR0104505100021314 Date ( Time ): 10/05/2013 ( 13:06:18 )

Servicing Branch : 435 LIC of India, Naihati Branch Office 48 Arbinda Sarani. Naihati 24 Parganas N W B Naihati 743165

RENEWAL PREMIUM ACKNOWLEDGEMENT

Received with thanks Rs. 24455.30 through Payment Gateway over the Internet from: Smt./Ms./Shri : Soumili Bandyopadhyay(L/A) Towards the following Policy No Name Agency Code 428206526
Bandyopdhyay S

02274435 428206528
Bandyopadhyay S

Plan Term D.O.C. 184 22 02/02/2010 168 16 02/02/2010

Inst. Prem(Rs) Mode Sum Assured 9,907.00 YLY 1,75,000.00 13,981.00 YLY 2,00,000.00 23,888.00

No Of Inst Due Fr Due To 1 02/13 02/13 1 02/13 02/13

Total Premium Late Fee 9,907.00 235.30 13,981.00 332.00 23,888.00 567.30 23,888.00 567.30

Service Tax Edu Cess Total Amt 0.00 0.00 10,142.30 0.00 0.00 14,313.00 0.00 0.00 24,455.30 0.00 0.00 24,455.30

Branch Next Due 435 02/14 435 02/14

02274435 Page Total (Rs)

Grand Total (Rs)

23,888.00

RUPEES TWENTY-FOUR THOUSAND FOUR HUNDRED FIFTY-FIVE AND THIRTY PAISE ONLY Soumili Bandyopadhyay(L/A) D/O Sandeep Bandyopadhyay(Prop) 26,Gobinda Sen Road,Po-Gorifa Dt- 24 Pgs N 743166 Payment Acknowledgement generated through Online Portal on 05-Jan-2014 Time : 19:47:22. Digitally Signed Premium Receipt sent by email

This receipt is electronically generated.

Signature Not Verified

Digitally signed by Rekha Varshney Date: January 5, 2014 7:47:22 PM IST Reason: Premium Receipt Location: LIC OF INDIA

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