Collecting Branch : EPS1 Servicing Branch : 762

E-mail : bo_eps1@licindia.com LIC of India,Tirupur Br Office

Phone : +91-022-1251 P B No-401
1 Mangalam Road Lakshmi Complex.
Transaction No. : PR0208947800021011 Tirupur (Tn)
Tirupur
Date ( Time ): 11/10/2010 ( 18:49:46 ) Tamilnadu 641604

RENEWAL PREMIUM RECEIPT

Received with thanks Rs. 6776.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Sri.C.Mallikarjuna Reddy

Towards the following

Policy No Plan Inst. Prem(Rs) No Of Inst Total Premium Branch

Name Term Mode Due Fr Late Fee Next Due
Agency Code D.O.C. Sum Assured Due To Total Amt
761312011 111 1,198.00 1 1,198.00 762
Reddy C.M 29 YLY 08/10 8.00 08/11
04240762 27/08/1994 1,00,000.00 08/10 1,206.00
762358342 93 5,570.00 1 5,570.00 762
C.M.Reddy C 25 YLY 09/10 0.00 09/11
04205762 28/09/1999 1,00,000.00 09/10 5,570.00
Page Total (Rs) 6,768.00 6,768.00
8.00
6,776.00
Grand Total (Rs) 6,768.00 6,768.00
8.00
6,776.00

RUPEES SIX THOUSAND SEVEN HUNDRED SEVENTY-SIX ONLY

Sri.C.Mallikarjuna Reddy A.Mu.Sh.2010/1304/CR 324/M 1 Dated 23/06/2010

186,V.S.Sivasubramaniam Nagar,
Ranganathapuram,Sirupooluvapattip.O
Tirupur
641603

This receipt is electronically generated and is digitally signed.

Signature Not Verified

Digitally signed by REKHA VARSHNEY
Date: October 11, 2010 6:49:46 PM IST
Reason: Premium Receipt
Location: LIC OF INDIA

Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi

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