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Servicing Office Address

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Mangaldoi Branch,Annada Bhaban, Mangaldoi Tangla Road, Ward No 9,

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Bheberghat, Mangaldoi, Dist: Darrang, Assam, Pin : 784125

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GSTIN No: 18AAACN9967E1Z2

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RECEIPT

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Customer Details Collection Details

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Name : Mr MADHUSMITA GOHAIN Agent Code : 9000162854

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Address : C/O SIMANTA DEKA , C/O N TALUKDAR , Collection Number : 20080381240000000685

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HNO - 06 JANATA PATH BHETAPARA Collection Date : 18/04/2024

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GUWHATI KAMRUP ASSAM , ASSAM , Bank Account : 9172

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Pin Code : 781038

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Received with thanks from Sri/Smt Mr MADHUSMITA GOHAIN

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a sum of 7006 (RUPEES SEVEN THOUSAND SIX ONLY) by CD
towards 1 Year Package Policy Policy as per details given hereunder

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Sl Policy Number TR Code End/Ren/Dec/Clm End/Ren/Dec/Clm A/C Particulars A/C Head Credit Amount Debit Amount Amount

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No. Year Number (General Ledger) Received

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1
1 20080331246160000391 11 C.D CONTROL A/C 5076 0.00 7006.00 -7006.00

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2 20080331246160000391 11 CASH PREMIUM A/C 5083 5938.00 0.00 5938.00
00
3 20080331246160000391 11 CGST_AS_Int_Liab 7310 534.00 0.00 534.00
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4 20080331246160000391 11 SGST_AS_Int_Liab 7311 534.00 0.00 534.00

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TOTAL : 7006.00 7006.00 0.00

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Particulars : CD
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For National Insurance Company Ltd.,

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1.Please quote collection no. and date in all correspondeces

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2.The stamp has been defaced and retained at the office against the issued
policy.
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3.We hereby declare that though our aggregate turnover in any preceding
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financial year from 2017-18 onwards is more than the aggregate turnover
notified under sub-rule (4) of rule 48, we are not required to prepare an invoice
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in terms of the provisions of the said sub-rule.

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Authorised Signatory
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NIC/UBPORTAL/9000162854 18/04/2024 05:50 PM

Visit us at https://nationalinsurance.nic.co.in for information on Products, Services and Grievance Redressal.
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