ORIGINAL RECEIPT
LIC RENEWAL PREMIUM RECEIPT
Date:

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KIOSK ID/LOCATION MPONLINE TRANS.ID RECEIPT NO.
POLICY HOLDER NAME POLICY NO. SERVICING BRANCH CODE
INSTALMENT PREMIUM NO. OF DUES PREMIUM DUE DATE
PREMIUM AMOUNT Rs. LATE FEE Rs. TOTAL AMOUNT Rs.
PAYMENT MODE CHEQUE NO. /CASH CASH  NEXT DUE

LIC contact:
PCMC,Net work operating center,1st flr.
Jeevan seva Annexe, S.V.Road, Santacruz(w),
Mumbai-400 054. Phone:022 1251
e-mail:bo_cbk1@licindia.com