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308922886_1

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


LIC OF INDIA,UTHAMAPALAYAM
Transaction No : 12079297
3-3-23 KATCHERY
Date ( Time ): 15/07/2021 ( 15:14:28 ) TAMILNADU,626533
Email: BO_74D@LICINDIA.COM
Receipt No : PR1207929700012122
Call Center No: 022 6827 6827

RENEWAL PREMIUM RECEIPT

Received with thanks ` 1,09,503.62 through Payment Gateway over the Internet from:

Smt./Ms./Shri : L. Surulinathan B.E.,


towards the following :

Policy No Plan / Term Inst. Premium No Of Inst Total Premium CGST Branch
Name D.O.C. Mode Due From Late Fee SGST/UTGST Next Due
Revival Sum Assured Due To CD Charges Total Amt Reg. No.
Agency Code
(Yes/No) (`) (`) (`)
308922886 836 / 21 1,07,094.00 1 1,07,094.00 1,204.81 74D
L. Surulinathan 25/06/2018 YLY 06/21 0.00 1,204.81 06/22
No 06/21 0.00 1,09,503.62 33AAACL0582H1ZT
0104774D 20,00,000

Page Total (`) 1,07,094.00 1,07,094.00 1,204.81


0.00 1,204.81
0.00 1,09,503.62
Grand Total (`) 1,07,094.00 1,07,094.00 1,204.81
0.00 1,204.81
0.00 1,09,503.62

ONE LAKH NINE THOUSAND FIVE HUNDRED THREE RUPEES AND SIXTY TWO PAISE ONLY

L. Surulinathan B.E.,
Consolidated Stamp Duty Paid
S/O Lakshmanan
51, West Street, Visuvasapuram CSD/70/2021/2092 DATED - 24.06.2021
Dompuchery Po,Bodi Tk, Theni Dt

625582 Payment Acknowledgement generated through


Online Portal on 15-Jul-21 Time : 15:18:23.
Mobile: 96******49
Email: na********93@gmail.com
For Payment related queries-Email: bo_eps1@licindia.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!

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