20/05/2024

504982

IRDAI Registration Number 241 (Composite Broker) BALLIA - IPC

Abulaas Parvez

Payment Collection Receipt (Fresh)

Product and Client Summary

Product Type Name of Company Name Application No. Client name Client Address Client Contact No
(Insurer's Name) /Policy No
Life Insurance HDFC Life Insurance 11123 GITA MISHRA Ballia 8808652526
Company Limited
Payment Summary

Payment Date 20/05/2024 Premium Pay Mode : CASH,CHEQUE

Total Policy Premium 100000
Cheque INR: 51000 Cheque No: 000071
Total Collected Prem (in figures)** 100000 Cash INR: 49000
Total Collected Prem (in Words)** One Lakh Only
Due Payment (If any) 0