Received With Thanks ' 3,062.00 Through Payment Gateway Over The Internet From

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Collecting Branch : EPS1 Servicing Branch : LIC of India, Guduvada Br

P B No-16 Railway Feeder Road


Transaction No : 22221195
Pedayerukapadu.,Gudivada Andhra
Date ( Time ): 14/03/2018 ( 14:57:03 ) Gudivada,521301
[email protected]
Receipt No : PR2222119500011718
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

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

Smt./Ms./Shri : Jaddu Sarada


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.
(`) (`) (`)
676647956 165 3,062.00 1 3,062.00 0.00 692
Jaddu Sarada 20 QLY 03/18 0.00 0.00 06/18
01105692 28/06/2013 2,50,000 03/18 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

Jaddu Sarada
D/O Satyanarayana,
Dno.16/402-1, Womens College Road
Chowdarypeta, Gudivada

521301 Payment Acknowledgement generated through


Online Portal on 14-Mar-18 Time : 14:59:34.
Mobile: 9741364419
Email: [email protected]

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!

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