Collecting Branch : EPS1 Servicing Branch : 71M

E-mail : bo_eps1@licindia.com LIC of India,Chennai City Br Office-XVI

Phone : +91-022-1251 37 1st Main Road
Gandhi Nagar
Transaction No. : PR0236118400021011 Adyar
Chennai
Date ( Time ): 02/11/2010 ( 12:49:00 ) Tamil Nadu 600020

RENEWAL PREMIUM RECEIPT

Received with thanks Rs. 3315.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : S.Indrani

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
713861507 149 1,554.00 1 1,554.00 71M
Indrani S 62 QLY 11/10 0.00 02/11
0137071M 13/11/2003 1,00,000.00 11/10 1,554.00
713861523 75 1,761.00 1 1,761.00 71M
Indrani S 20 QLY 11/10 0.00 02/11
0137071M 13/11/2003 1,00,000.00 11/10 1,761.00
Page Total (Rs) 3,315.00 3,315.00
0.00
3,315.00
Grand Total (Rs) 3,315.00 3,315.00
0.00
3,315.00

RUPEES THREE THOUSAND THREE HUNDRED FIFTEEN ONLY

S.Indrani
Old No. 14,Komalammal Flats,
F-2 North Tank Sq Street,,
Triplicane, Chennai.
600005

This receipt is electronically generated and is digitally signed.

Validity unknown
Digitally signed by REKHA VARSHNEY
Date: November 2, 2010 12:49:00 PM IST
Reason: Premium Receipt
Location: LIC OF INDIA

Zindagi Ke Saath Bhi, Zindagi Ke Baad Bhi

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