Collecting Branch : EPS1 Servicing Branch : LIC of India, Arrah Branch

Mahavir Tola.
Transaction No : 6705203
Arrah Bihar,
Date ( Time ): 12/07/2018 ( 22:46:44 ) Arrah,802301
bo_eps1@licindia.com
Receipt No : PR0670520300011819
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 3,062.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Kamlesh Bharti

towards the following :

Policy No Plan Inst. Premium No Of Inst Total Premium CGST Branch

Name Term Mode Due From Late Fee SGST/UTGST Next Due
Agency Code D.O.C. Sum Assured Due To CD Charges Total Amt Reg. No.
(`) (`) (`)
519038425 165 3,062.00 1 3,062.00 0.00 528
Kamlesh Bharti 21 QLY 06/18 0.00 0.00 09/18
04390528 26/03/2012 2,50,000 06/18 0.00 3,062.00

Page Total (`) 3,062.00 3,062.00 0.00

0.00 0.00
0.00 3,062.00
Grand Total (`) 3,062.00 3,062.00 0.00
0.00 0.00
0.00 3,062.00

GST borne by LIC of India ` 68.90

THREE THOUSAND SIXTY TWO RUPEES AND ZERO PAISE ONLY

Kamlesh Bharti
S/O Sri Raj Kishore Bharti
Vill-Jhawan Ke Mathiya,P.O-Benwaliya
P/S- Bihiya,Dist- Bhojpur`

802151 Payment Acknowledgement generated through

Online Portal on 13-Jul-18 Time : 05:57:45.
Mobile: 9992435196
Email: kbharti78@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!