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Collecting Branch : EPS1 Servicing Branch : 71A

E-mail : bo_eps1@licindia.com LIC of India, Tambaram Br Office


Phone : +91-022-1251 17 Upstairs
Shanmugam Road
Transaction No. : PR1381914700021617 West Tambaram
Tambaram
Date ( Time ): 06/01/2017 ( 16:36:47 ) Tamil Nadu 600045

RENEWAL PREMIUM ACKNOWLEDGEMENT

Received with thanks Rs. 2927.40 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Vinoth S

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 CD Charges Total Amt
705223575 88 1,051.00 1 1,051.00 0.00 71A
Vinoth S 25 QLY 10/16 16.60 0.00 01/17
0362771A 28/01/2010 1,00,000.00 10/16 0.00 1,067.60
705438048 165 919.00 2 1,838.00 0.00 71A
Vinoth S 20 QLY 09/16 21.80 0.00 03/17
0362771A 28/09/2010 75,000.00 12/16 0.00 1,859.80
Page Total (Rs) 1,970.00 2,889.00 0.00
38.40 0.00
0.00 2,927.40
Grand Total (Rs) 1,970.00 2,889.00 0.00
38.40 0.00
0.00 2,927.40

RUPEES TWO THOUSAND NINE HUNDRED TWENTY-SEVEN AND FORTY PAISE ONLY

Vinoth S Payment Acknowledgement generated through Online


1/113,West Street Portal on 09-Jan-2017 Time : 09:23:11.
Chithirappatti
Thuraiyur Tk Trichy Dist
621010

This receipt is electronically generated.

Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi


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