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Renewal Premium Receipt: Collecting Branch: E-Mail: Phone: Transaction No.: Date (Time) : Servicing Branch

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This document is a renewal premium receipt from LIC of India acknowledging receipt of Rs. 2066 from R.Ranjith Jacob towards renewal of his life insurance policy number 705079657, which has a sum assured of Rs. 105,000 and was originally issued on January 28, 2010. The receipt provides details of the collecting and servicing branches, transaction number, date, policy details, payment amount, and policyholder information.

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Renewal Premium Receipt: Collecting Branch: E-Mail: Phone: Transaction No.: Date (Time) : Servicing Branch

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PrmPayRcpt-PR0496743600011516

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Renewal Premium Receipt: Collecting Branch: E-Mail: Phone: Transaction No.: Date (Time) : Servicing Branch

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Collecting Branch : EPS1

E-mail : bo_eps1@licindia.com
Phone : +91-022-1251

Servicing Branch : 729

LIC of India, Chennai (CBO-IX)
4th Floor Apex Chambers
20 Sir Thiyagaraya Road
T. Nagar
Chennai
Tamil Nadu 600017

Transaction No. : PR0496743600011516

Date ( Time ): 03/08/2015 ( 23:43:59 )

RENEWAL PREMIUM RECEIPT

Received with thanks Rs. 2066.00 through Payment Gateway over the Internet from:
Smt./Ms./Shri : R.Ranjith Jacob
Towards the following
Policy No
Name
Agency Code
705079657

Plan
Term
D.O.C.
108
Ranjith Jacob R
25
00748729
28/01/2010
Page Total (Rs)

Inst. Prem(Rs)
Mode
Sum Assured
2,066.00
QLY
1,05,000.00
2,066.00

Grand Total (Rs)

2,066.00

No Of Inst
Due Fr
Due To
1
07/15
07/15

Total Premium
Late Fee
2,066.00
0.00
2,066.00
0.00
2,066.00
0.00

Service Tax
Edu Cess
Total Amt
0.00
0.00
2,066.00
0.00
0.00
2,066.00
0.00
0.00
2,066.00

Branch
Next Due
729
10/15

RUPEES TWO THOUSAND SIXTY-SIX ONLY

R.Ranjith Jacob
S/O J.Jacob,4,Bharat Nagar,
2nd Karukku St,(S.V.KalyanamandapamBackside,Menambedu,Ambathur,Chenna
600053
This receipt is electronically generated.

Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi

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