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Renewal Premium Acknowledgement: 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
Transaction No. : PR1525986700011415
Date ( Time ): 23/03/2015 ( 11:43:56 )

Servicing Branch : 71M


LIC of India, Chennai City Br Office-XVI
37 1st Main Road
Gandhi Nagar
Adyar
Chennai
Tamil Nadu 600020

RENEWAL PREMIUM ACKNOWLEDGEMENT


Received with thanks Rs. 28642.00 through Payment Gateway over the Internet from:
Smt./Ms./Shri : P.Niranjani
Towards the following
Policy No
Name
Agency Code
705590603

Plan
Term
D.O.C.
14
Niranjani
P
15
0184871M
17/03/2011
Page Total (Rs)

Grand Total (Rs)

Inst. Prem(Rs)
Mode
Sum Assured
28,642.00
YLY
4,00,000.00
28,642.00

28,642.00

No Of Inst
Due Fr
Due To
1
03/15
03/15

Total Premium
Late Fee
28,642.00
0.00
28,642.00
0.00
28,642.00
0.00

Service Tax
Edu Cess
Total Amt
0.00
0.00
28,642.00
0.00
0.00
28,642.00
0.00
0.00
28,642.00

Branch
Next Due
71M
03/16

RUPEES TWENTY-EIGHT THOUSAND SIX HUNDRED FORTY-TWO ONLY


P.Niranjani
New No.11,Old No.6
State Bank Colony
Pazhavanthangal,Chennai
600114

Payment Acknowledgement generated through Online


Portal on 23-Mar-2015 Time : 11:46:41.

This receipt is electronically generated.

Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi


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