Collecting Branch : EPS1 E-mail : [email protected] Phone : +91-022-1251 Transaction No. : PR0910972900011415 Date ( Time ): 28/11/2014 ( 16:31:32 ) Servicing Branch : 61F LIC of India, Indiranagar Br Office Jeevan Jyothi NEXT TO BDA Complex III Floor Indiranagar II Stage Bangalore 560038 RENEWAL PREMIUM RECEIPT Received with thanks Rs. 25714.00 through Payment Gateway over the Internet from: Smt./Ms./Shri : Sarthak Kanungo Towards the following Policy No Name Agency Code 698672395 Plan Term D.O.C. 149 Sarthak 67 00000 24/12/2013 Page Total (Rs) Grand Total (Rs) Inst. Prem(Rs) Mode Sum Assured 25,714.00 YLY 6,00,000.00 25,714.00 25,714.00 No Of Inst Due Fr Due To 1 12/14 12/14 Total Premium Late Fee 25,714.00 0.00 25,714.00 0.00 25,714.00 0.00 Service Tax Edu Cess Total Amt 0.00 0.00 25,714.00 0.00 0.00 25,714.00 0.00 0.00 25,714.00 Branch Next Due 61F 12/15 RUPEES TWENTY-FIVE THOUSAND SEVEN HUNDRED FOURTEEN ONLY Sarthak Kanungo 23, 2nd Floor, East Pace Post Office Road, Bellandur Bangalore 560103 A.Mu.Sh.2014/1706/CR 251/M-1 Dated 30/06/2014 This receipt is electronically generated. Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi Page 1of1
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