Collecting Branch : EPS1 E-mail :
[email protected] Phone : +91-022-1251 Transaction No. : PR0274452600011213 Date ( Time ): 31/07/2012 ( 17:54:19 )
Servicing Branch : 34S LIC of India,Barwaha Branch Suraj Market 1 Floor Narmada Road Barwaha Barwah 451115
RENEWAL PREMIUM RECEIPT Received with thanks Rs. 10874.00 through Payment Gateway over the Internet from: Smt./Ms./Shri : Sourabh S/O.Ashok Kumar Bajpai Towards the following Policy No Name Agency Code 345266449 Sourabh Sab
Plan Term D.O.C. 149 77 21/08/2008
0034034S Page Total (Rs)
Grand Total (Rs)
Inst. Prem(Rs) Mode Sum Assured 10,874.00 YLY 2,00,000.00
No Of Inst Due Fr Due To 1 08/12 08/12
Total Premium Late Fee 10,874.00 0.00
10,874.00
10,874.00 0.00
10,874.00
10,874.00 0.00
Service Tax Edu Cess Total Amt 0.00 0.00 10,874.00
Branch Next Due 34S 08/13
0.00 0.00 10,874.00 0.00 0.00 10,874.00
RUPEES TEN THOUSAND EIGHT HUNDRED SEVENTY-FOUR ONLY Sourabh S/O.Ashok Kumar Bajpai Dashahara Maidan,Patel Colony, Barwaha Dt.Khargone Mp 451115
Mudrank : A.Mu.Sh.2012/CR 63/M-1 Dated 03/02/2012
This receipt is electronically generated and is digitally signed.
Signature Not Verified Digitally signed by REKHA VARSHNEY Date: July 31, 2012 5:54:19 PM IST Reason: Premium Receipt Location: LIC OF INDIA
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