Collecting Branch : EPS1 Servicing Branch : 114

E-mail : bo_eps1@licindia.com LIC of India, Delhi Br Unit 114

Phone : +91-022-1251 Sterling House, 15/16
Netaji Subhash Marg
Transaction No. : PR0092773900011415 Darya Ganj
New Delhi
Date ( Time ): 28/04/2014 ( 21:56:21 ) New Delhi 110002

RENEWAL PREMIUM RECEIPT

Received with thanks Rs. 5448.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Dr.Anita Arora

Towards the following

Policy No Plan Inst. Prem(Rs) No Of Inst Total Premium Service Tax Branch
Name Term Mode Due Fr Late Fee Edu Cess Next Due
Agency Code D.O.C. Sum Assured Due To Total Amt
120758828 93 5,448.00 1 5,448.00 0.00 114
Arora A 25 YLY 04/14 0.00 0.00 04/15
64829111 28/04/1998 1,00,000.00 04/14 5,448.00
Page Total (Rs) 5,448.00 5,448.00 0.00
0.00 0.00
5,448.00
Grand Total (Rs) 5,448.00 5,448.00 0.00
0.00 0.00
5,448.00

RUPEES FIVE THOUSAND FOUR HUNDRED FORTY-EIGHT ONLY

Dr.Anita Arora A.Mu.Sh.2014/486/C.R 64/M-1 Dated 17/02/2014

A-4/66 Konark Apptt.
Kalkaji Extn.
New Delhi 110019

This receipt is electronically generated.

Signature Not Verified

Digitally signed by Rekha Varshney
Date: April 28, 2014 9:56:21 PM IST
Reason: Premium Receipt
Location: LIC OF INDIA

Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi

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