Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi

Collecting Branch : EPS1E-mail : bo_eps1@licindia.comPhone : +91-022-1251

Transaction No. : PR1357207600011415

Date ( Time ): 19/02/2015 ( 07:37:19 )

Servicing Branch : 674LIC of India, Kakinada BranchL I C Buildings P B No 26Subhas Road Kakinada.Dt E Godavary A PKakinada533001

RENEWAL PREMIUM ACKNOWLEDGEMENT

Received with thanks Rs. 16055.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Markondapatnaikuni Sai RavitejTowards the following

Policy NoName

Agency Code

PlanTerm

D.O.C.

Inst. Prem(Rs)Mode

Sum Assured

No Of InstDue FrDue To

Total PremiumLate Fee

Service TaxEdu CessTotal Amt

BranchNext Due

802856108Msr Tej Msrt

04381674

17420

28/01/2006

16,055.00YLY

5,00,000.00

101/1501/15

16,055.000.00

0.000.00

16,055.00

67401/16

Page Total (Rs) 16,055.00 16,055.000.00

0.000.00

16,055.00Grand Total (Rs) 16,055.00 16,055.00

0.000.000.00

16,055.00

RUPEES SIXTEEN THOUSAND FIFTY-FIVE ONLY

Markondapatnaikuni Sai RavitejS/O Mpv Prasad,Plot No:176,Hno:70-17-27/1a,Rr Nagar,Nfcl Road,Kakinada533003

Payment Acknowledgement generated through OnlinePortal on 19-Feb-2015 Time : 07:40:38.

This receipt is electronically generated.

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