Collecting Branch : EPS1 Branch Code : EPS1

PCMC, Network Operating Center

Transaction No. : PR0216535800010910 1st Floor, Jeevan Seva Annexe,
S.V.Road, Santacruz(W)
Date ( Time ): 29/12/2009 ( 13:37:32 ) Mumbai - 400 054
Ph. : +91-022-1251
e-mail : bo_eps1@licindia.com

RENEWAL PREMIUM RECEIPT

Received with thanks Rs. 6,005.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Sandhya Singh

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
124643526 165 6,005.00 1 6,005.00 123
Smt Ss 20 YLY 12/09 0.00 12/10
11037123 24/12/2008 1,25,000.00 12/09 6,005.00
Page Total (Rs) 6,005.00 6,005.00
0.00
6,005.00
Grand Total (Rs) 6,005.00 6,005.00
0.00
6,005.00

RUPEES SIX THOUSAND FIVE ONLY

Sandhya Singh Mudrank 0915/2969/CR 331/M 1 Dated 23/09/2009

H-No-96-Pkt-A
Himalaya Appartment Sect-2 Rohini
Delhi
110085

This receipt is electronically generated and is digitally signed.

Signature Not Verified

Digitally signed by REKHA VARSHNEY
Date: December 29, 2009 1:37:32 PM IST
Reason: Premium Receipt
Location: LIC OF INDIA

Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi

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