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UNITED INDIA INSURANCE COMPANY LIMITED

RECEIPT
Issuing Office 091401 / BO KOVILPATTI Receipt
10109140123116254693
code/Address : CATHOLIC CENTRE924-A, MAIN Number :
ROAD, KOVILPATTI628501 Collection
04/02/2024
Date :

Received with thanks from A ATHIAPPAN S/O ANANTHAPPA NADAR (Customer ID :

23031113955, Customer GST/UIN No :Not Available) a sum of Rs. 1039.00( One thousand thirty-
nine rupees only) as per detail given hereunder:
SL Endt/Ren/Clm/Decln Total
Policy Number Policy Type Particulars
No No Amount
Final
1 0914013123P114459651 TwoWheeler 0 881.00
Premium
2 0914013123P114459651 TwoWheeler 0 CGST 79.00
3 0914013123P114459651 TwoWheeler 0 SGST 79.00
Total (Rounded Off) : 1,039.00
Stamp Duty : 0.00
Bank Charges : 0.00
Total Amount : 1,039.00

CD Details
SL CD Account CD Account Holder CD Account Holder Tagged
No Number ID Name Amount
1 C116071 AGD0111187 PERIYASAMY S 1,039.00
Particulars :
GSTIN (UIIC) : 33AAACU5552C1ZQ for UNITED INDIA INSURANCE COMPANY LIMITED

Cashier Initial AUTHORISED SIGNATORY

Note:
1. Receipt valid subject to realisation of cheque
2. Please quote policy no., collection no., and date in all correspondences.
CONSOLIDATED STAMPS DUTY PAID AS PER TAMILNADU GOVERNMENT G.O.(RT.)NO.146 DATED 28-03-2023 FOR THE PERIOD FROM 01-04-2023 TO 31-03-2024.