Shri Inst

Har Pal Aapke Sath!

Collecting Center : A***

Transaction No. : 15764881

Date ( Time ): 26/04/2021 ( 17:41:21 )

Branch Code : 381

LIC of India, Bhilai Branch Office I

LIC OF INDIA,BHILAI BRANCH OFFICE I

P B NO 22

CIVIC CENTRE BHILAI M P, 490001

email: ******@********.***

Call Center No: 022-********

RENEWAL PREMIUM RECEIPT

Received with thanks Rs. 4,721.00 from policyholder Shri/Smt.Tejram Yadav towards the following policy/ies

Policy No

Name

Revival

(Yes/No)

Plan

Term

D.O.C.

Inst. Prem(Rs)

Mode

Sum Assured

No Of Inst

Due Fr

Due To

Total Premium

Late Fee

CD Chgs +

Xcharge

CGST

SGST*/UTGST

Total Amt

Branch Agency

Code

Next Due

Reg. No.

386996579

Yadav T

Yes

165

25

21/04/2012

1,531.00

QLY

1,25,000.00

3

10/20

04/21

4,593.00

108.70

0.00 + 0.00

9.78

9.78

4,721.26

381-********

07/21

22AAACL0582H2ZV

Page Total (Rs) 1,531.00 4,593.00

108.70

0.00

9.78

9.78

4,721.26

Grand Total (Rs) 1,531.00 4,593.00

108.70

0.00

9.78

9.78

4,721.26

RUPEES FOUR THOUSAND SEVEN HUNDRED TWENTY-ONE ONLY Paid by Cash/Card/Sr :4,721.26

Paid by Cheque :0.00

Cheque No/ChequeDate : 0/

Tejram Yadav

Vill - Bahegaon

Tah-Lalburra

Dis. Balaghat, M.P.

481448.

Mobile:

Consolidated Stamp Duty Paid

For Life Insurance Corporation of India,

Smt.Neha Yadav(03690381)

*SGST also includes cess amount of Rs. 0.00.

GST and Cess borne by LIC of India is Rs 103.34

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