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Collecting Branch : EPS1 Servicing Branch : LIC of India, Calcutta (CBO-15)

Jeevan Jyoti
Transaction No : 1493811
47 Ashutosh Mukherjee Road
Date ( Time ): 21/04/2019 ( 08:40:56 ) Calcutta,700025
bo_eps1@licindia.com
Receipt No : PR0149381100011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 3,801.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Pulak Kundu


towards the following :

Policy No Plan Inst. Premium No Of Inst Total Premium CGST Branch


Name Term Mode Due From Late Fee SGST/UTGST Next Due
Agency Code D.O.C. Sum Assured Due To CD Charges Total Amt Reg. No.
(`) (`) (`)
417545055 14 3,801.00 1 3,801.00 0.00 426
Pulak Kundu 16 YLY 03/19 0.00 0.00 03/20
69626411 26/03/2007 50,000.00 03/19 0.00 3,801.00

Page Total (`) 3,801.00 3,801.00 0.00


0.00 0.00
0.00 3,801.00
Grand Total (`) 3,801.00 3,801.00 0.00
0.00 0.00
0.00 3,801.00

GST borne by LIC of India ` 85.52

THREE THOUSAND EIGHT HUNDRED ONE RUPEES AND ZERO PAISE ONLY

Pulak Kundu
Tentulberia
Sital Ch. Naskar Road
P O Garia Kolkata

700084 Payment Acknowledgement generated through


Online Portal on 21-Apr-19 Time : 08:43:53.
Mobile: 9433065782
Email: prat727@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!

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