THE NEW INDIA ASSURANCE CO. LTD.

(Government of India Undertaking)

COLLECTION RECEIPT CUM ADJUSTMENT VOUCHER

Issuing Office : N BLOCK,CONNAUGHT CIRCUS (310300)
Address : BOMBAY LIFE BUILDING, N-34, CONNAUGHT CIRCUS, NEW DELHI

,110001
NEW DELHI
Phone : 23723521
Email : nia.310300@newindia.co.in
Fax :
Collection Number : 31030081190000070784
Collection Date : 01/06/2019
Business Source Code : 2D10673292
PAN No of Payer :

Received with thanks from Ganesan .

The amount received/Adjusted is towards -

Policy No. A/C Description Amount` A/C Code Sub A/C Code
31030031190100074449 Bank-310300 965.00 9100.310300 BA00018819-310300-9100
Total = ` 965.00

Your Payment/Adjustment Details are as under -

Mode Amount ` Cheque Cheque Date Drawee Bank Drawee Branch Reference No. Scroll/BG/A
No. PD Balance
ECS 965.00 PB85745 N.A. N.A. N.A. 31030019172202976 N.A.
95
Total = ` 965.00

Utilization details of the Collected Amount :

Premium GST Stamp Duty Excess Amount
818.00 147.00 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: 01/06/2019

(MS. RASHMI LUCY

BARWA)
[SRDivisional 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.

Signature Not
Verified
Digitally signed
by Srinivasan
Vaideswaran
Date: 2019.06.01
17:26:55 IST
Policy No. : 31030031190100074449Document generated by Policy Bazaar at 01/06/2019 17:26:52 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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THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

Tax Invoice No : 31030019P0071851

IRDA Registration Number: 190

Policy No. : 31030031190100074449Document generated by Policy Bazaar at 01/06/2019 17:26:52 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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