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PaymentReceipt 16194646

This document is a renewal premium receipt for a payment of ₹7,329.00 made by Rashmi Ranjan Dash for policy number 858653737. The payment was processed on 10/08/2025 through an online payment gateway, and it includes details about the policy, such as the agency code, plan, and due dates. The receipt confirms that the payment acknowledgment was generated electronically and does not require a signature.

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ranjanriki99
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10 views1 page

PaymentReceipt 16194646

This document is a renewal premium receipt for a payment of ₹7,329.00 made by Rashmi Ranjan Dash for policy number 858653737. The payment was processed on 10/08/2025 through an online payment gateway, and it includes details about the policy, such as the agency code, plan, and due dates. The receipt confirms that the payment acknowledgment was generated electronically and does not require a signature.

Uploaded by

ranjanriki99
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

ranjanriki99@g

858653737_1

Collecting Branch : EPS1 Servicing Branch : LIC of India, Bhubaneswar


PLOT NO. A-1/64, PAIKANAGAR
Transaction No : 16194646
NEAR RENAULT SHOWROOM,
Date ( Time ): 10/08/2025 ( 10:43:16 ) BHUBANESWAR, ODISHA.,751003
Email: [email protected]
Receipt No : PR1619464600012526
Call Center No: 022 6827 6827

N
RENEWAL PREMIUM RECEIPT (Revival)

Received with thanks ` 7,329.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Rashmi Ranjan Dash


towards the following :
Policy No Plan / Term Inst. Premium No Of Inst Total Premium CGST Branch
Name Mode Due From Late Fee SGST/UTGST Next Due
D.O.C.
Sum Assured Due To CD Charges Total Amt
Revival Agency Code Reg. No.
(Yes/No) (`) (`) (`)
858653737 915 / 21 6,919.00 1 6,919.00 87.70 58S
Pallavi Sarangi 24/06/2021 QLY 06/25 109.60 87.70 09/25
Yes 0238758S 5,00,000 06/25 125.00 7,329.00 21AAACL0582H1ZY

Page Total (`) 6,919.00 6,919.00 87.70


109.60 87.70
125.00 7,329.00
Grand Total (`) 6,919.00 6,919.00 87.70
109.60 87.70
125.00 7,329.00

SEVEN THOUSAND THREE HUNDRED TWENTY NINE RUPEES AND ZERO PAISE ONLY

Rashmi Ranjan Dash


Consolidated Stamp Duty Paid
W/O-Rashmi Ranjan Dash
Mig-04,K9a Kalinga Vihar,Patrapada Stamp Duty of Rs. Four Crores paid vide Order LOA No.
Bhubaneswar,Dt-Khurda,Odisha

751019 Payment Acknowledgement generated through


Online Portal on 10-Aug-25 Time : 10:45:29.
Mobile: 91******68
Email: ra********[email protected]
For Payment related queries-Email: [email protected]

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!


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