Collecting Branch : EPS1 Servicing Branch : 226
E-mail : bo_eps1@licindia.com LIC of India,Lucknow City Branch
Phone : +91-022-1251 3rd Floor Halwasiya Market
Hazaratganj.
Transaction No. : PR0030489700011213 Lucknow
Lucknow City
Date ( Time ): 12/04/2012 ( 13:40:24 ) 226001
RENEWAL PREMIUM RECEIPT
Received with thanks Rs. 5088.00 through Payment Gateway over the Internet from:
Smt./Ms./Shri : Sri Vijay Kumar Gupta
Towards the following
Policy No Plan Inst. Prem(Rs) No Of Inst Total Premium Branch
Name Term Mode Due Fr Late Fee Next Due
Agency Code D.O.C. Sum Assured Due To Total Amt
280243915 93 5,088.00 1 5,088.00 226
Gupta Vk 25 YLY 03/12 0.00 03/13
00693289 21/03/1990 1,00,000.00 03/12 5,088.00
Page Total (Rs) 5,088.00 5,088.00
0.00
5,088.00
Grand Total (Rs) 5,088.00 5,088.00
0.00
5,088.00
RUPEES FIVE THOUSAND EIGHTY-EIGHT ONLY
Sri Vijay Kumar Gupta Duplicate receipt generated online through LIC Portal on
M M B 2/8,S B I Colony 12-Apr-2012 Time : 13:44:27
Sector-P,Aliganj
Lucknow
226024
This receipt is electronically generated and is digitally signed.
Signature Not Verified
Digitally signed by REKHA VARSHNEY
Date: April 12, 2012 1:44:27 PM IST
Reason: Premium Receipt
Location: LIC OF INDIA
Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi
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