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THE NEW INDIA ASSURANCE CO. LTD.

(Wholly owned by the Govt. of India)

COLLECTION RECEIPT CUM ADJUSTMENT VOUCHER


Issuing Office
Address

: JAIPUR D O 1 (330100)
: C. D. U. I, L&B-2 INDUSTRIAL AREA
NEAR GALAXY CINEMA
SFS MANSAROVER,302002
JAIPUR

Phone
Email
Fax

: 01412395531
: nia.330100@newindia.co.in
: 01412395419

Collection Number
Collection Date
Business Source Code

: 10000089160600087125
: 17/06/2016
: 1D4023409

Received with thanks from VINOD KUMAR GARG.


The amount received/Adjusted is towards Policy No.
A/C Description
33010031160100001855
Bank-100000

Amount`
843.00

A/C Code
9100.100000

Sub A/C Code


BA00013647-100000-9100

Total = ` 843.00
Your Payment/Adjustment Details are as under Mode
Amount ` Cheque
Cheque
No.
Date
EPG
Credit
Advice

843.00

QR111
21178

N.A.

Drawee Bank

Drawee
Branch

N.A.

N.A.

Reference No.

3301001610003691

Scroll/BG/
APD
Balance
N.A.

Total = ` 843.00
Utilization details of the Collected Amount :
Premium
Service Tax
733.00
110.00
Sl no.
Agency Code
1
NIA1D4019864

Stamp Duty
0.00

Excess Amount
0
Department Code
31

Agency Name
KAVITA BACHWANI

For The New India Assurance Company Limited

Revenue Stamp
__________
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Date of Issue: 17/06/2016

(Mr. Jagdish Prasad Chouhan)


[DIV. MANAGER]

Cashier's Initial

Authorized Signatory

NIA S.T.REGN No: AAACN4165CST178.

Policy No. : 33010031160100001855Document generated by QR_RENEWAL at 17/06/2016 13:48:54 Hours.


Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Page No. 1

THE NEW INDIA ASSURANCE CO. LTD.


(Wholly owned by the Govt. of India)

Note 1.Please quote 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.

IRDA Registration Number: 190

Policy No. : 33010031160100001855Document generated by QR_RENEWAL at 17/06/2016 13:48:54 Hours.


Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Page No. 2

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