THE NEW INDIA ASSURANCE CO. LTD.

(Government of India Undertaking)

COLLECTION RECEIPT CUM ADJUSTMENT VOUCHER

Issuing Office : THE NEW INDIA ASSURANCE CO. LTD., KANAKAPURA ROAD (670202)
Address : BRANCH (670202) NO.1A, SBI COLONY, (ABOVE BATA SHOW ROOM)
41ST MAIN, J.P.NAGAR 1ST PHASE,
SARAKKI GATE, KANAKAPURA ROAD,,560078
BANGALORE
Insured Pan Number : AJXPS7844N
Phone : 08022443967
Email : nia.670202@newindia.co.in
Fax : 08022443967
Collection Number : 10000089220500233777
Collection Date : 15/05/2022
Business Source Code : 1D7821762
PAN No of Payer : AJXPS7844N

Received with thanks from MR. P.R. SREEKANTH.

The amount received/Adjusted is towards -

Policy No. A/C Description Amount` A/C Code Sub A/C Code
67020234227800000021 Bank-100000 9912.00 9100.100000 BA00013647-100000-9100
Total = ` 9912.00

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 9912.00 WAX611 N.A. N.A. N.A. 6702022210001781 N.A.
Credit 4852
Advice 2588
Total = ` 9912.00

Utilization details of the Collected Amount :

Premium GST Stamp Duty Excess Amount
8400.00 1512.00 0.00 0
Sl no. Agency Code Agency Name Department Code
1 NIAAG00057913 KUMARA S 34

For The New India Assurance Company Limited

Revenue Stamp
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Date of Issue: 15/05/2022

(Mrs. K ADITYAVALLI)
[BRANCH 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: 2022.05.15
21:20:10 IST
Policy No. : 67020234227800000021Document generated by QR_RENEWAL at 15/05/2022 21:20:08 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 : 67020222P0000871

IRDA Registration Number: 190

NIA PAN NUMBER: AAACN4165C

Policy No. : 67020234227800000021Document generated by QR_RENEWAL at 15/05/2022 21:20:08 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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