The Oriental Insurance Company Ltd.

CBO - ALLAHABAD 14/18, LAL BAHADUR SHASTRI MARG , CIVIL LINES , ALLAHABAD , ALLAHABAD , 211008
GST NO : 09AAACT0627R4ZU
RECEIPT

Office Code & Name : 224302 - CBO1 ALLAHABAD Bank Code : 9100(C-PORTAL-01)
Collection No. : 51-01/9455014015 Posted Doc No. : 9455014014
Collection Date : 17/02/2020 10:51 Posted Doc Dt.. : 17/02/2020
Received with thanks From Sh./Smt./ M/s. : MRS. SONAWATI DEVI
The Sum of : Indian Rupees Six Thousand Ninety-Nine Only

Towards the following : Premium collections

Sl Dept. Policy No. Policy End/Ren/Dec/ Dev. Off. Code Source Amount C/D GL SL Code Pay Bank Bank Instrument Instr. Dt./CC
No. Code Status Claim No. Code Collected Code Mode Name Branch No. Exp. Dt.

1 48 2020/1761 New NA0000008717 BA00001 6,099.00 C 5083 AC0000002350 CC ICICI ***********00 27/02/2020
Policy 12103 91
Total 6,099.00

GST : Rs. 930

FOR THE ORIENTAL INSURANCE COMPANY LTD
GST NO Of Insured : 09AAACT0627R4ZU
Policy Type / Zone : PNB-ORIENTAL Re. 1/-
MEDICLAIM Rev. Stamp
POLICY-2017- UIN
:OICHLGP18074V01
1718

This Receipt is Electronically Generated

CIN: U66010DL1947GOI007158 IRDA Regn. No. 556 - All the amounts mentioned in this report are in Indian Rupees