THE NEW INDIA ASSURANCE CO. LTD.

(Wholly owned by the Govt. of India)

COLLECTION RECEIPT CUM ADJUSTMENT VOUCHER

Issuing Office : DIGITAL HUB (830000)
Address : 41B, 4TH FLOOR, MAKER TOWER E, CUFFE PARADE, MUMBAI 400005

,400005
MUMBAI
Phone : 2222150330
Email : nia.830000@newindia.co.in
Fax :
Collection Number : 10000089170100059500
Collection Date : 06/01/2018
Business Source Code : DI830000
PAN No of Payer : DNUPK4987C

Received with thanks from PRABHAT BHUSHAN.

The amount received/Adjusted is towards -

Policy No. A/C Description Amount` A/C Code Sub A/C Code
83000031170500014385 Bank-100000 2726.00 9100.100000 BA00013647-100000-9100
Total = ` 2726.00

Your Payment/Adjustment Details are as under -

Mode Amount ` Cheque Cheque Date Drawee Bank Drawee Branch Reference No. Scroll/BG/A
No. PD Balance
EPG 2726.00 LHDF59 N.A. N.A. N.A. 8300001710209729 N.A.
Credit 4406
Advice 0689
Total = ` 2726.00

Utilization details of the Collected Amount :

Premium GST Stamp Duty Excess Amount
2310.00 416.00 0.00 0
Sl no. Agency Code Agency Name Department Code
1 NA NA 31

For The New India Assurance Company Limited

Revenue Stamp
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Date of Issue: 06/01/2018

( C.S. AYYAPPAN)
[CHIEF MANAGER]

Cashier's Initial Authorized Signatory

Note -
1.Please note the Policy Number, Collection Number and date in all future correspondence. .
2.NIA shall not be liable for any claim arising out of sales made during the period between the due date and date of payment of the
installment if the premium paid has been exhausted by turnover declarations/if there is insufficient premium balance.

Tax Invoice No : 8300003100014385

IRDA Registration Number: 190

Signature Not
Verified
Digitally signed
by Srinivasan
Vaideswaran
Date: 2018.01.06
10:06:15 IST
Policy No. : 83000031170500014385Document generated by CUST899465 at 06/01/2018 10:06:15 Hours.
Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.

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