Received With Thanks ' 1,836.00 Through Payment Gateway Over The Internet From

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Collecting Branch : EPS1 Servicing Branch : LIC of India, Trivandrum City

P B No-17
Transaction No : 19072750
Lic Building M G
Date ( Time ): 04/09/2020 ( 13:37:16 ) Trivandrum,695001
[email protected]
Receipt No : PR1907275000012021
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 1,836.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : R Nirmala
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
Revival D.O.C. Sum Assured Due To CD Charges Total Amt Reg. No.
(Yes/No) (`) (`) (`)
785429846 179 1,836.00 1 1,836.00 0.00 786
R Nirmala 16 QLY 09/20 0.00 0.00 12/20
No 11/03/2013 09/20 0.00 1,836.00 32AAACL0582H1ZV
80,000.00

Page Total (`) 1,836.00 1,836.00 0.00


0.00 0.00
0.00 1,836.00
Grand Total (`) 1,836.00 1,836.00 0.00
0.00 0.00
0.00 1,836.00

GST and State Cess borne 43.62


ONE THOUSAND EIGHT HUNDRED THIRTY SIX RUPEES AND ZERO PAISE ONLY

R Nirmala
W/O Mr.S.Raju, Aiswarya, Tc 64/1121/3
Thekkumthala Road, Karumom P.O
Trivandrum

695002 Payment Acknowledgement generated through


Online Portal on 04-Sep-20 Time : 13:39:52.
Mobile: 94******39
Email: su********[email protected]

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!

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