Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi

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

Transaction No. : PR1129133000011516

Date ( Time ): 21/12/2015 ( 19:14:46 )

Servicing Branch : 659LIC of India, Cuddapah Branch OfficeNagarajupet P B No 52.Cuddapah A P

Cuddapah516001

RENEWAL PREMIUM RECEIPT

Received with thanks Rs. 1442.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Sri Kota Nala Manikanta Kumar

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

650928241K N Manikantaku Mar

01307659

10230

17/12/1991

1,442.00HLY

1,00,000.00

112/1512/15

1,442.000.00

0.000.00

1,442.00

65906/16

Page Total (Rs) 1,442.00 1,442.000.00

0.000.00

1,442.00Grand Total (Rs) 1,442.00 1,442.00

0.000.000.00

1,442.00

RUPEES ONE THOUSAND FOUR HUNDRED FORTY-TWO ONLY

Sri Kota Nala Manikanta KumarS/O K Narasimha RaoSri Vasavi Traders, 17/205 UpstairsMundy Bazar, Kadapa.516001

This receipt is electronically generated.

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