OmniOMS Output Generation

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Feb 21, 2018 - Received with thanks ` 21,522.00 through Payment Gateway over the Internet from: Receipt No : Mohamed Rafi. HelpDesk: +91-022-1251.
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!