64VB Receipt Page 1 of 1

United India Insurance Company

Limited
Head Office:24, Whites Road , Chennai - 600 014, Website :
http://www.uiic.co.in
CERTIFICATE IN RESPECT OF COMPLIANCE OF
SECTION 64 VB OF INSURANCE ACT 1938

Re: Policy No : 2501003120P112395666 Office Code: 250100 Office Name: DO DEHRADUN

Insured Name: ROHAN GUPTA

a) Date of commencement of risk: 29/01/2021

b) Actual premium payable under the policy/renewal/cover note:

Policy No. Endt. No. Endt. Start Dt. Premium Amt.(Rs.) Receipt No. Receipt Date
2501003120P112395666 0 NA 12,556.00 10125010020113458849 27/01/2021

Payment ID Payment Date Scroll Date Excess Amt.(Rs.) Money Receipt/Voucher No Money Receipt/Voucher Date
120250100110318649 27/01/2021 27/01/2021 0.00 10225010020107758575 27/01/2021

c) Whether the premium paid was provisional at or final and if provisional, reason thereof: NO

Payment Mode Amount(Rs.) Cheque/APD/BG No. Cheque/BG Exp.Date Realised On Drawn on Bank/APD/BG Balance Branch
Cheque 12,556.00 656591 27/01/2021 30/01/2021 STATE BANK OF INDIA. DDN

d) Whether Bank Guarantee was invoked: NO

Date of invocation: NA

e) Payment of Premium under bank Guarantee: NA

f) In view of the details a) to e) above whether 64VB of Insurance Act is complied with: YES

AO/Acct. Officer Branch Incharge Divisional Incharge Regional Incharge

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