Collecting Branch : EPS1
Servicing Branch : LIC of India, Panchkula Branch
Transaction No : 20342531
Bay No. 71-72 Sector 2 Panchkula.,
Date ( Time ): 21/02/2018 ( 07:52:17 ) Receipt No :
Panchkula,134109
[email protected] HelpDesk: +91-022-1251
PR2034253100011718
RENEWAL PREMIUM RECEIPT Received with thanks ` 21,522.00 through Payment Gateway over the Internet from: Smt./Ms./Shri :
Mohamed Rafi
towards the following : Policy No Name Agency Code
Plan Term D.O.C.
Inst. Premium Mode Sum Assured
No Of Inst Due From Due To
Total Premium Late Fee CD Charges
(`)
(`) 177398543 Mohamed Rafis
90 18
0088116N
28/02/2011
21,522.00 YLY 4,00,000
CGST SGST/UTGST Total Amt
Branch Next Due Reg. No.
(`) 0.00
16N
02/18
21,522.00 0.00
0.00
02/19
02/18
0.00
21,522.00
1
Page Total (`)
21,522.00
21,522.00 0.00 0.00
0.00 0.00 21,522.00
Grand Total (`)
21,522.00
21,522.00 0.00
0.00 0.00 21,522.00
0.00
GST borne by LIC of India ` 484.24 TWENTY ONE THOUSAND FIVE HUNDRED TWENTY TWO RUPEES AND ZERO PAISE ONLY Mohamed Rafi
Consolidated Stamp Duty Paid
# 984-A, Ff, Sec-16, Panchkula Haryana
AMuSh2016/2967/CR747/M1 w.e.f. 30/11/2016
134113 Mobile: 8283085118 Email:
[email protected]
Payment Acknowledgement generated through Online Portal on 21-Feb-18 Time : 07:53:46.
This receipt is electronically generated and no signature is required. Har Pal Aapke Saath!