National Insurance Company Limited Endorsement Certificate Page 1 of 1

ORIGINAL FOR RECIPIENT/DUPLICATE FOR SUPPLIER

Tax Invoice/Endorsement Certificate
National Insurance Company Limited
CIN NO.: U10200WB1906GOI001713
GSTIN : 06AAACN9967E2Z6
Address : Rohtak Division II, Narain Shopping Complex, Civil Road, Rohtak, Haryana-124001
Tel. : 011-22404471/011 23326557 Fax : 011- 23321281
Email Incharge.390101@nic.co.in
IRDA Reg No.: 58
State Name : Haryana

Endorsement Schedule
Endorsement No. 42060031221148664447 / 962023 / 1 Endorsement Date 09-Jun-2023 10:11:24
Policy No 42060031221148664447 Policy Type Package Policy
Risk Inception Date 02-Jan-2023 Policy Expiry Date 01-Jan-2024
Invoice No. 4131226958527E01 Original Invoice No. 4131226958527
Accounting Code of Service 997134
Insured Name MR SADANAND
Insured Address S/O. SH KARAMBIR SINGH WARD NO. 10 ,BHAIYAN WALI GALI, SAMPLA (36) (36)SAMPLA, 9671213599,
Insured State name & Code Haryana-06
Place of Supply Haryana
GSTIN of Customer GSTUNREGISTERED
Type of Endorsement NCB - Recovery
Part A Premium 809
Part B Premium 0
Endorsement Charges(Taxable
809
Value)
CGST @ 9% 73
SGST @ 9% 73
Total Endorsement Charges 955

At the request of the insured, it is hereby declared and agreed that the following items under the withstanding policy has been changed / altered.

Notwithstanding anything herein to the contrary contained, at the request of the insured, it is hereby declared and agreed that under the within mentioned
policy.

THE CORRECT

SNO. Endorsed Field New Value Old Value

1 NCB RECOVERY
2 NCB RECOVERY NCB RECOVERY
3 Title MR MR
4 First Name SADANAND SADANAND
5 Vehicle Registration No HR-95--5212 HR955212

And not as stated therein.

Subject to fulfillment of conditions, if any,mentioned in remarks

I / We hereby certify that the policy to which this certificate relates as well as this certificate of We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18
insurance are issued in accordance with the provisions of chapter X and chapter XI of M.V. act, onwards is more than the aggregate turnover notified under sub-rule (4) of rule 48, we are not
1988. required to prepare an invoice in terms of the provisions of the said sub-rule.
For National Insurance Company Limited

Authorized Signatory
Remarks: approved

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