Collecting Branch : EPS1 E-mail : bo_eps1@licindia.com Phone : +91-022-1251
Servicing Branch : 73N LIC of India,Arni Branch No.286 Sathiyamoorthy Road Arni. Tiruvannamalai District Arni 632301
Transaction No. : PR1095586600011112 Date ( Time ): 10/02/2012 ( 11:40:46 )
RENEWAL PREMIUM RECEIPT Received with thanks Rs. 8621.00 through Payment Gateway over the Internet from: Smt./Ms./Shri : S.Rajeshkumar Towards the following Policy No Name Agency Code 735107724 Rajesh Kumar S
Plan Term D.O.C. 179 20 14/07/2008
01756732 Page Total (Rs)
Inst. Prem(Rs) Mode Sum Assured 8,621.00 HLY 5,00,000.00
No Of Inst Due Fr Due To 1 01/12 01/12
8,621.00
Grand Total (Rs)
Total Premium Late Fee Total Amt 8,621.00 0.00 8,621.00
Branch Next Due 73N 07/12
8,621.00 0.00 8,621.00 8,621.00 0.00 8,621.00
8,621.00
RUPEES EIGHT THOUSAND SIX HUNDRED TWENTY-ONE ONLY S.Rajeshkumar S/O.M.Settu, #86,Anna Nagar, Kammavanpettai,Vellore Tk. 632319
Mudrank A.Mu.Sh.2011/CR 310/M-1 dated 07/07/2011
This receipt is electronically generated and is digitally signed.
Signature Not Verified Digitally signed by REKHA VARSHNEY Date: February 13, 2012 5:09:48 PM IST Reason: Premium Receipt Location: LIC OF INDIA
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