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Received with thanks from Mr.RAM GOPAL TRIPATHI a sum of Rs. 1,191.

00 (Rupees One Thousand One Hundred Ninety


One Only ) by way of EASI Bill Desk towards the following transactions.

1 31 2023 451201312210005619 451201 Motor - Two Wheelers


16 9000138784 Direct Premium 1,009.00
CGST 91.00
SGST 91.00
Total 1,191.00
Receipt is subject to realisation of cheque when payment is made by cheque. Our document number and Date, Policy year and
Number should be quoted in all correspondence with us only to the Policy issuing office address mentioned above. Revenue
stamp has to be affixed when the amount is or above Rs. 5000.

We hereby declare that though our aggregate turnover in any preceding 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 in terms of the provisions of
the said sub-rule

Printed on 20/03/2023 by 45120199 Page No : 2

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