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

Civil Lines
Transaction No : 4188166
Khandwa,
Date ( Time ): 28/05/2019 ( 10:10:50 ) Khandwa,450001
bo_eps1@licindia.com
Receipt No : PR0418816600041920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 1,427.20 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Sourabh Pawar

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.
(`) (`) (`)
348004938 149 1,401.00 1 1,401.00 2.00 387
Sourabh 77 QLY 03/19 22.20 2.00 06/19
04990387 28/12/2013 1,00,000 03/19 0.00 1,427.20

Page Total (`) 1,401.00 1,401.00 2.00

22.20 2.00
0.00 1,427.20
Grand Total (`) 1,401.00 1,401.00 2.00
22.20 2.00
0.00 1,427.20

GST borne by LIC of India ` 31.52

ONE THOUSAND FOUR HUNDRED TWENTY SEVEN RUPEES AND TWENTY PAISE ONLY

Sourabh Pawar
Vidha Nagar Postal Colony
Sihada Road Khandwa
Mp

450000 Payment Acknowledgement generated through

Online Portal on 28-May-19 Time : 10:13:47.
Mobile: 9165567795
Email: pawar.sourabh6@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!

 Collecting Branch : EPS1 Servicing Branch : LIC of India, Khandwa Branch
Civil Lines
Transaction No : 4188166
Khandwa,
Date ( Time ): 28/05/2019 ( 10:10:50 ) Khandwa,450001
bo_eps1@licindia.com
Receipt No : PR0418816600041920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 1,427.20 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Sourabh Pawar

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.
(`) (`) (`)
348004936 149 1,401.00 1 1,401.00 2.00 387
Sourabh 77 QLY 03/19 22.20 2.00 06/19
04990387 28/12/2013 1,00,000 03/19 0.00 1,427.20

Page Total (`) 1,401.00 1,401.00 2.00

22.20 2.00
0.00 1,427.20
Grand Total (`) 1,401.00 1,401.00 2.00
22.20 2.00
0.00 1,427.20

GST borne by LIC of India ` 31.52

ONE THOUSAND FOUR HUNDRED TWENTY SEVEN RUPEES AND TWENTY PAISE ONLY

Sourabh Pawar
Vidha Nagar Postal Colony
Sihada Road Khandwa
Mp

450000 Payment Acknowledgement generated through

Online Portal on 28-May-19 Time : 10:13:47.
Mobile: 9165567795
Email: pawar.sourabh6@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!

 Collecting Branch : EPS1 Servicing Branch : LIC of India, Khandwa Branch
Civil Lines
Transaction No : 4188166
Khandwa,
Date ( Time ): 28/05/2019 ( 10:10:50 ) Khandwa,450001
bo_eps1@licindia.com
Receipt No : PR0418816600041920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 1,646.78 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Sourabh Pawar

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.
(`) (`) (`)
344815700 75 812.00 2 1,624.00 1.74 387
Sourabh S/O 20 QLY 02/19 19.30 1.74 08/19
04990387 28/11/2005 50,000.00 05/19 0.00 1,646.78

Page Total (`) 812.00 1,624.00 1.74

19.30 1.74
0.00 1,646.78
Grand Total (`) 812.00 1,624.00 1.74
19.30 1.74
0.00 1,646.78

GST borne by LIC of India ` 36.54

ONE THOUSAND SIX HUNDRED FORTY SIX RUPEES AND SEVENTY EIGHT PAISE ONLY

Sourabh Pawar
Vidha Nagar Postal Colony
Sihada Road Khandwa
Mp

450000 Payment Acknowledgement generated through

Online Portal on 28-May-19 Time : 10:13:47.
Mobile: 9165567795
Email: pawar.sourabh6@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!

 Collecting Branch : EPS1 Servicing Branch : LIC of India, Khandwa Branch
Civil Lines
Transaction No : 4188166
Khandwa,
Date ( Time ): 28/05/2019 ( 10:10:50 ) Khandwa,450001
bo_eps1@licindia.com
Receipt No : PR0418816600041920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 927.62 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Sourabh Pawar

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.
(`) (`) (`)
345543555 165 919.00 1 919.00 0.66 387
Sorab 10 QLY 04/19 7.30 0.66 07/19
04990387 15/10/2009 75,000.00 04/19 0.00 927.62

Page Total (`) 919.00 919.00 0.66

7.30 0.66
0.00 927.62
Grand Total (`) 919.00 919.00 0.66
7.30 0.66
0.00 927.62

GST borne by LIC of India ` 20.68

NINE HUNDRED TWENTY SEVEN RUPEES AND SIXTY TWO PAISE ONLY

Sourabh Pawar
Vidha Nagar Postal Colony
Sihada Road Khandwa
Mp

450000 Payment Acknowledgement generated through

Online Portal on 28-May-19 Time : 10:13:47.
Mobile: 9165567795
Email: pawar.sourabh6@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!