THE NEW INDIA ASSURANCE CO. LTD.

(Government of India Undertaking)

COLLECTION RECEIPT CUM ADJUSTMENT VOUCHER

Issuing Office : CHANNA COMPLEX (311300)
Address : CHANA COMPLEX 4TH FLOOR 2213 GURUDWARA RD KAROL BAGH NEW DE

,110005
NEW DELHI
Phone : 28756371
Email : nia.311300@newindia.co.in
Fax :
Collection Number : 31130081200000008364
Collection Date : 08/08/2020
Business Source Code : 2D10673662
PAN No of Payer :

Received with thanks from MR SATYA PAL.

The amount received/Adjusted is towards -

Policy No. A/C Description Amount` A/C Code Sub A/C Code
Total = ` 1063.00

Your Payment/Adjustment Details are as under -

Mode Amount ` Cheque Cheque Date Drawee Bank Drawee Branch Reference No. Scroll/BG/A
No. PD Balance
ECS 1063.00 SAXG90 N.A. N.A. N.A. 3113002010259754 N.A.
9184
2582
Total = ` 1063.00

Utilization details of the Collected Amount :

Premium GST Stamp Duty Excess Amount
901.00 162.00 0.00 0
Sl no. Agency Code Agency Name Department Code
1 NA NA 31

For The New India Assurance Company Limited

Revenue Stamp
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Date of Issue: 08/08/2020

(Mrs. Satya Manjula)

[Sr. Div. Manager]

Cashier's Initial Authorized Signatory

Note -
1.Please note the Policy Number, Collection Number and date in all future correspondence. .
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 : 31130020P0009512

IRDA Registration Number: 190

Signature Not
Verified
Digitally signed
by Srinivasan
Vaideswaran
Date: 2020.08.08
16:12:43 IST
Policy No. : 31130031200100007521Document generated by EASYPOL at 08/08/2020 16:12:38 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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