Received With Thanks ' 14,858.00 Through Payment Gateway Over The Internet From

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Collecting Branch : EPS1 Servicing Branch : LIC of India, Shahdol Branch

Nr Rajendra Talkies
Transaction No : 26216714
Main Rd.,Shahdol M P
Date ( Time ): 10/02/2020 ( 10:45:15 ) Shahdol,484001
[email protected]
Receipt No : PR2621671400011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 14,858.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Sri Sadashiv Tiwari


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.
(`) (`) (`)
377898373 159 14,858.00 1 14,858.00 0.00 370
Harsh Tiwari La 26 YLY 02/20 0.00 0.00 02/21
04758370 16/02/2003 02/20 0.00 14,858.00 23AAACL0582H2ZT
2,00,000

Page Total (`) 14,858.00 14,858.00 0.00


0.00 0.00
0.00 14,858.00
Grand Total (`) 14,858.00 14,858.00 0.00
0.00 0.00
0.00 14,858.00

GST borne by LIC of India ` 334.30


FOURTEEN THOUSAND EIGHT HUNDRED FIFTY EIGHT RUPEES AND ZERO PAISE ONLY

Sri Sadashiv Tiwari


Consolidated Stamp Duty Paid
Chandrabhaga Sadan
Nehru Colony Pandav Nagar Ward No 6 CSD/328/2019/646/19 DTD.15/02/2019
Shahdol Mp

484001 Payment Acknowledgement generated through


Online Portal on 10-Feb-20 Time : 10:47:54.
Mobile: 9926364724
Email: [email protected]

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!

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