Collecting Branch : EPS1 Servicing Branch : 641

E-mail : bo_eps1@licindia.com LIC of India, Hyderabad City Br I

Phone : +91-022-1251 Surabhi Arcade
5-7-664 Bank Street.
Transaction No. : PR0482860100011718 Koti Hyderabad A P
Hyd-Cbo-1
Date ( Time ): 11/07/2017 ( 13:51:38 ) 500001

RENEWAL PREMIUM ACKNOWLEDGEMENT

Received with thanks Rs. 10421.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Dvnl Ganeshwara Rao

Towards the following

Policy No Plan Inst. Prem(Rs) No Of Inst Total Premium Tax * Branch

Name Term Mode Due Fr Late Fee Total Amt Next Due
Agency Code D.O.C. Sum Assured Due To CD Charges Reg. No.
646796704 93 10,421.00 1 10,421.00 0.00 641
Ganeshwara Rao Dvnl 25 YLY 07/17 0.00 10,421.00 07/18
00800698 07/07/2006 2,00,000.00 07/17 0.00 36AAACL0582H1ZN
Page Total (Rs) 10,421.00 10,421.00 0.00
0.00 10,421.00
0.00
Grand Total (Rs) 10,421.00 10,421.00 0.00
0.00 10,421.00
0.00

RUPEES TEN THOUSAND FOUR HUNDRED TWENTY-ONE ONLY

Dvnl Ganeshwara Rao Payment Acknowledgement generated through Online

Hno 12-2-417/A/9 Portal on 11-Jul-2017 Time : 15:39:08.
Lic Colony,Gudimalkapur
Mehidipatnam, Hyderabad
500028

This receipt is electronically generated.

*Tax here indicates Goods and Services Tax(GST) from 1 July 2017 or Service Tax prior to 1 July 2017.

Har Pal Aap Ke Saath

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