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ffnrf,+] Rnfr qqr i'./ Insured PAN i o o o 1 q { q q wt iqful Issued Date: 3U03l2023 (2O7el12l t7)
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h{r"T / Particulars {+q { /AmountRs.
ffiq (./ Poticy No. 0924111520 l2LOOO87 drqrgza / premium 42,L20.00
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E $frsrfi-q 6qrt q wr {drt r fi{ +ff 1:%q,,f,r l13%oYAf 5,478.20
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Date : 31.10312023 (2:o79lLzlt7)

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INSURAI.}{C*E
Sfqi'. : +1\3\e-o1-{il?1Yo, +1e3-o1-{31i1/1 Receipt No.: 15122123100I665
{ :{:},'tr", } F4qq {. I +a,e€-.)1_t:lqi€t po.Box. No.:15123
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Print Time 3:11 PM
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D.O./Agent : 0467/0000
Insured Name & Address: Siddhartha Bank Limited,Butwal,
Siddhartha Cardboard Factory Pvt. Ltd,Omsatlya Gaa. pa6. Kataiya Rupandehi
Received with thanks a sum of Rupees 47,6L8.2o by Cash:. 0.00 by Cheque :. 0.00
( In words: Rupee Fourty Seven Thousand Six Hundred Eighteen Rupees and by Credit advice :. 47,6a8,2O
Twenty Paisa Only/ Acc. Adjustment: 0.00
Guarantee No. : Guarantee Bank: Bank Guarantee 0.00
In settlentent ol Bill/Policy No. t5l22l23lOOt66s o924r7152Ol2LOOO87 Policy date 3Ll03l2023
Cheque No :

Cheque Bank :

Premium 42,L20.00 Cr. A. Bank: Siddhartha Bank Ltd,-Hattisar-O01O1928620

RSD/lvlD/Terr. 0.00
Stamp Duty 20,00 Remarks:
Taxable Amount 42,140.00

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13 % VAT 5,478.20
Total 47$18.20
fo4 Prudential Insurance Co. Ltd.
Excess Amount

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Received Amount Rs. 47,6La,2O Authorised Siqnature

Printed By:Renuka Malla Thakuri . Printed On: 3UO3/2023 At: 3!11:51PM

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