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THE NEW INDIA ASSURANCE CO. LTD.

(Wholly owned by the Govt. of India)

COLLECTION RECEIPT CUM ADJUSTMENT VOUCHER


Issuing Office : HIMAYATNAGAR (CDUI) (610100)
Address : ANASUYA COMPLEX HIMAYATNAGAR, PO BOX NO. 1051, HYDERABAD 500029

,500029
Hyderabad
Phone : 04023221235
Email : nia.610100@newindia.co.in
Fax : 04023261055
Collection Number : 10000089180400010784
Collection Date : 05/04/2018
Business Source Code : 1D3937265
PAN No of Payer :

Received with thanks from MAMTA H BHAGCHANDANI ..

The amount received/Adjusted is towards -


Policy No. A/C Description Amount` A/C Code Sub A/C Code
61010031180300000352 Bank-100000 1338.00 9100.100000 BA00013647-100000-9100
Total = ` 1338.00

Your Payment/Adjustment Details are as under -


Mode Amount ` Cheque Cheque Date Drawee Bank Drawee Branch Reference No. Scroll/BG/A
No. PD Balance
EPG 1338.00 LMBK61 N.A. N.A. N.A. 6101001810003267 N.A.
Credit 9326
Advice 1217
Total = ` 1338.00

Utilization details of the Collected Amount :


Premium GST Stamp Duty Excess Amount
1134.00 204.00 0.00 0
Sl no. Agency Code Agency Name Department Code
1 NIAAG00039920 MANJULA A 31

For The New India Assurance Company Limited


Revenue Stamp
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Date of Issue: 05/04/2018

(Mr. RAJENDRA
KAMBLE)
[DIVISIONAL
MANAGER]

VAISHNOI AUTOMOBILES Cashier's Initial Authorized Signatory


2-40/5/1, PLOT NO.148, KONDAPUR VILLAGE,
SERILINGAMPALLY MANDAL,
RR DISTRICT, HYDERABAD
Hyderabad
TELANGANA
INDIA

Note -
1.Please note the Policy Number, Collection Number and date in all future correspondence. .
Signature Not
Verified
Digitally signed
by Srinivasan
Vaideswaran
Date: 2018.04.05
12:20:28 IST
Policy No. : 61010031180300000352Document generated by CUST978309 at 05/04/2018 12:20:26 Hours.
Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.

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THE NEW INDIA ASSURANCE CO. LTD.
(Wholly owned by the Govt. of India)

2.NIA shall not be liable for any claim arising out of sales made during the period between the due date and date of payment of the
installment if the premium paid has been exhausted by turnover declarations/if there is insufficient premium balance.

Tax Invoice No : 6101003103000352

IRDA Registration Number: 190

Policy No. : 61010031180300000352Document generated by CUST978309 at 05/04/2018 12:20:26 Hours.


Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.

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