Collecting Branch : EPS1 Servicing Branch : 514

E-mail : bo_eps1@licindia.com LIC of India, Begusarai Branch Office

Phone : +91-022-1251 P O Begusarai Main Road.
Dist Brgusarai
Transaction No. : PR1509382800011718
Begusarai
Date ( Time ): 19/12/2017 ( 09:23:11 ) 805110

RENEWAL PREMIUM ACKNOWLEDGEMENT

Received with thanks Rs. 20250.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Sikha

Towards the following

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

Name Term Mode Due Fr Late Fee SGST/UTGST Next Due
Agency D.O.C. Sum Assured Due To CD Charges Total Amt Reg. No.
Code
529430981 149 20,250.00 1 20,250.00 0.00 514
SS 75 YLY 11/17 0.00 0.00 11/18
026490514 28/11/2012 5,00,000.00 11/17 0.00 20,250.00 10AAACL0582H2Z0
Page Total (Rs) 20,250.00 20,250.00 0.00
0.00 0.00
0.00 20,250.00
Grand Total (Rs) 20,250.00 20,250.00 0.00
0.00 0.00
0.00 20,250.00

RUPEES TWENTY THOUSAND TWO HUNDRED FIFTY ONLY

Sikha Payment Acknowledgement generated through Online

C/O Sri Rajniti Kumar Portal on 19-Dec-2017 Time : 09:24:03.
Q.No-D2f/71,Po-B.R.T.S
Dt- Begusarai
851117

This receipt is electronically generated.

**GST borne by LIC of India is Rs 455.62

Har Pal Aap Ke Saath

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