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Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi Collecting Branch : EPS1 E-mail : [email protected] Phone : +91-022-1251 Transaction No. : PR1097887800011516 Date ( Time ): 16/12/2015 ( 07:24:06 ) Servicing Branch : 67C LIC of India, Br Office, P B No 14 P B No. 14 Kota Vari Street Railpet. Repalle (Ap) Repalle 522265 RENEWAL PREMIUM ACKNOWLEDGEMENT Received with thanks Rs. 7338.00 through Payment Gateway over the Internet from: Smt./Ms./Shri : Chitte Hari Prasad Towards the following Policy No Name Agency Code Plan Term D.O.C. Inst. Prem(Rs) Mode Sum Assured No Of Inst Due Fr Due To Total Premium Late Fee Service Tax Edu Cess Total Amt Branch Next Due 676381441 Prasad Chh 0067767C 149 72 15/12/2009 7,338.00 HLY 2,00,000.00 1 12/15 12/15 7,338.00 0.00 0.00 0.00 7,338.00 67C 06/16 Page Total (Rs) 7,338.00 7,338.00 0.00 0.00 0.00 7,338.00 Grand Total (Rs) 7,338.00 7,338.00 0.00 0.00 0.00 7,338.00 RUPEES SEVEN THOUSAND THREE HUNDRED THIRTY-EIGHT ONLY Chitte Hari Prasad S/O Ch P Rangaiah C/O Ch Murali Krishna,D No 6-280, Dwaraka Nagar,Tirupathi,Chittor D 517505 Payment Acknowledgement generated through Online Portal on 28-Dec-2015 Time : 15:37:16. This receipt is electronically generated. Page 1of1

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Page 1: PrmPayRcpt-b nbnPR1097887800011516 (1)

Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi

Collecting Branch : EPS1E-mail : [email protected] : +91-022-1251

Transaction No. : PR1097887800011516

Date ( Time ): 16/12/2015 ( 07:24:06 )

Servicing Branch : 67CLIC of India, Br Office, P B No 14P B No. 14 Kota Vari StreetRailpet.Repalle (Ap)Repalle522265

RENEWAL PREMIUM ACKNOWLEDGEMENT

Received with thanks Rs. 7338.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Chitte Hari Prasad

Towards 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

676381441Prasad Chh

0067767C

14972

15/12/2009

7,338.00HLY

2,00,000.00

112/1512/15

7,338.000.00

0.000.00

7,338.00

67C06/16

Page Total (Rs) 7,338.00 7,338.000.00

0.000.00

7,338.00Grand Total (Rs) 7,338.00 7,338.00

0.000.000.00

7,338.00

RUPEES SEVEN THOUSAND THREE HUNDRED THIRTY-EIGHT ONLY

Chitte Hari PrasadS/O Ch P RangaiahC/O Ch Murali Krishna,D No 6-280,Dwaraka Nagar,Tirupathi,Chittor D517505

Payment Acknowledgement generated through OnlinePortal on 28-Dec-2015 Time : 15:37:16.

This receipt is electronically generated.

Page 1of1

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