Renewal Premium Receipt: Collecting Branch: E-Mail: Phone: Transaction No.: Date (Time) : Servicing Branch

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Collecting Branch : EPS1 Servicing Branch : 568

E-mail : [email protected] LIC of India, Dhanbad Branch I


Phone : +91-022-1251 Dr B Prasads Bldg
Barwa Road P B No 54.
Transaction No. : PR0612138700011516 Dhanbad
Dhanbad I
Date ( Time ): 31/08/2020 ( 17:48:47 ) 826001

RENEWAL PREMIUM RECEIPT

Received with thanks Rs. 82,994.00 through Payment Gateway over the Internet

from: Smt./Ms./Shri : Tarique Anwar Khan

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
547099489 14 82,994.00 1 82,994.00 0.00 568
T A Khan 21 YLY 08/19 0.00 0.00 08/21
04833568 04/08/2010 17,00,000.00 08/20 82,994.00
Page Total (Rs) 82,994.00 82,994.00 0.00
0.00 0.00
82,994.00
Grand Total (Rs) 82,994.00 82,994.00 0.00
0.00 0.00
82,994.00

RUPEES EIGHTY-TWO THOUSAND NINE HUNDRED NINETY-FOUR ONLY

Tarique Anwar Khan A.Mu.Sh.2015/CR 242/M-1 Dated 15/05/2020


F- 487, Zalam
Muhall
Tuglakabad Village
New Delhi
New Delhi
110044
This receipt is electronically generated.

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