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UNITED INDIA INSURANCE COMPANY LIMITED

 
RECEIPT
Issuing Office 070801 / BO K.S.RAO.ROAD Receipt
10107080121106394140
code/Address : 76K.S.RAO ROAD, OPP: POPULAR BUILDING, Number :
HAMPANAKATTA575001 Collection
17/09/2021
Date :

Received with thanks from KURIAN P J (Customer ID : 23009581697, Customer GST/UIN No :Not Available) a sum of
Rs. 9476.00( Nine thousand four hundred seventy-six rupees only) as per detail given hereunder:
SL Endt/Ren/Clm/Decln Total
Policy Number Policy Type Particulars
No No Amount
Final
1 0708012821P105959693 IndividualFamilyMedicarePolicy 0 8,030.00
Premium
2 0708012821P105959693 IndividualFamilyMedicarePolicy 0 CGST 723.00
3 0708012821P105959693 IndividualFamilyMedicarePolicy 0 SGST 723.00
Total (Rounded Off) : 9,476.00
Stamp Duty : 0.00
Bank Charges : 0.00
Total Amount : 9,476.00

Instrument Details
SL Mode of Instrument Bank Branch Tagged
Payment ID Instrument Number
No Payment Date Name Name Amount
PAYMENT
Canara
1 121070801104776824 GATEWAY 20210917111212800110168297744142445 17/09/2021   9,476.00
Bank
- PAYTM
Particulars :  
GSTIN (UIIC) :   29AAACU5552C1ZF for UNITED INDIA INSURANCE COMPANY LIMITED

Cashier Initial AUTHORISED SIGNATORY

Note:
1. Receipt valid subject to realisation of cheque
2. Please quote policy no., collection no., and date in all correspondences.

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