Received With Thanks ' 13,282.28 Through Payment Gateway Over The Internet From

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

D No 19-1-204 Main Road


Transaction No : 13777390
Near Kanyaka Parameshwari
Date ( Time ): 25/09/2019 ( 16:19:31 ) Peddapuram,533437
[email protected]
Receipt No : PR1377739000011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 13,282.28 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Kommoju Ramavenkata Satyavaralakshmi


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.
(`) (`) (`)
805650471 836 12,990.00 1 12,990.00 146.14 69F
Kommoju 21 YLY 09/19 0.00 146.14 09/20
0025169F 06/09/2018 2,00,000 09/19 0.00 13,282.28 0

Page Total (`) 12,990.00 12,990.00 146.14


0.00 146.14
0.00 13,282.28
Grand Total (`) 12,990.00 12,990.00 146.14
0.00 146.14
0.00 13,282.28

THIRTEEN THOUSAND TWO HUNDRED EIGHTY TWO RUPEES AND TWENTY EIGHT PAISE ONLY

Kommoju Ramavenkata Satyavaralakshmi


Consolidated Stamp Duty Paid
W/O K.Appalaraju,
76-5-38, Plno 202, Sangeeth Soudha Aprts CSD/328/2019/646/19 DTD.15/02/2019
Gandhipuram 2, Rajahmundry.

533103 Payment Acknowledgement generated through


Online Portal on 25-Sep-19 Time : 16:25:17.
Mobile: 9866882976
Email: [email protected]

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!

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