Received With Thanks ' 4,040.92 Through Payment Gateway Over The Internet From

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Collecting Branch : EPS1 Servicing Branch : LIC of India, Polur Br Office

Sannathi Street.
Transaction No : 17047152
Polur,
Date ( Time ): 03/11/2019 ( 15:31:16 ) Polur,606803
bo_eps1@licindia.com
Receipt No : PR1704715200011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 4,040.92 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Karthik R
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.
(`) (`) (`)
736650865 820 3,952.00 1 3,952.00 44.46 7276
R.Karthik 20 QLY 11/19 0.00 44.46 02/20
102167276 28/08/2014 11/19 0.00 4,040.92 33AAACL0582H1ZT
2,00,000

Page Total (`) 3,952.00 3,952.00 44.46


0.00 44.46
0.00 4,040.92
Grand Total (`) 3,952.00 3,952.00 44.46
0.00 44.46
0.00 4,040.92

FOUR THOUSAND FORTY RUPEES AND NINETY TWO PAISE ONLY

Karthik R
S/O M.Rajendran,
19,Mohaideenbeig St,
Polur, T V Malai Dt.

606803 Payment Acknowledgement generated through


Online Portal on 21-Jan-20 Time : 23:39:52.
Mobile: 8861116920
Email: biokarthik811@yahoo.co.in

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!


Collecting Branch : EPS1 Servicing Branch : LIC of India, Polur Br Office
Sannathi Street.
Transaction No : 11312025
Polur,
Date ( Time ): 30/08/2019 ( 08:10:33 ) Polur,606803
bo_eps1@licindia.com
Receipt No : PR1131202500011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 4,040.92 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Karthik R
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.
(`) (`) (`)
736650865 820 3,952.00 1 3,952.00 44.46 7276
R.Karthik 20 QLY 08/19 0.00 44.46 11/19
102167276 28/08/2014 08/19 0.00 4,040.92 33AAACL0582H1ZT
2,00,000

Page Total (`) 3,952.00 3,952.00 44.46


0.00 44.46
0.00 4,040.92
Grand Total (`) 3,952.00 3,952.00 44.46
0.00 44.46
0.00 4,040.92

FOUR THOUSAND FORTY RUPEES AND NINETY TWO PAISE ONLY

Karthik R
S/O M.Rajendran,
19,Mohaideenbeig St,
Polur, T V Malai Dt.

606803 Payment Acknowledgement generated through


Online Portal on 21-Jan-20 Time : 23:39:52.
Mobile: 8861116920
Email: biokarthik811@yahoo.co.in

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!


Collecting Branch : EPS1 Servicing Branch : LIC of India, Polur Br Office
Sannathi Street.
Transaction No : 2723686
Polur,
Date ( Time ): 07/05/2019 ( 08:46:06 ) Polur,606803
bo_eps1@licindia.com
Receipt No : PR0272368600011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 4,040.92 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Karthik R
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.
(`) (`) (`)
736650865 820 3,952.00 1 3,952.00 44.46 7276
R.Karthik 20 QLY 05/19 0.00 44.46 08/19
102167276 28/08/2014 05/19 0.00 4,040.92 33AAACL0582H1ZT
2,00,000

Page Total (`) 3,952.00 3,952.00 44.46


0.00 44.46
0.00 4,040.92
Grand Total (`) 3,952.00 3,952.00 44.46
0.00 44.46
0.00 4,040.92

FOUR THOUSAND FORTY RUPEES AND NINETY TWO PAISE ONLY

Karthik R
S/O M.Rajendran,
19,Mohaideenbeig St,
Polur, T V Malai Dt.

606803 Payment Acknowledgement generated through


Online Portal on 21-Jan-20 Time : 23:39:52.
Mobile: 8861116920
Email: biokarthik811@yahoo.co.in

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!

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