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THE NEW INDIA ASSURANCE CO. LTD.

(Wholly owned by the Govt. of India)

COLLECTION RECEIPT CUM ADJUSTMENT VOUCHER


Issuing Office : N BLOCK,CONNAUGHT CIRCUS (310300)
Address : BOMBAY LIFE BUILDING, N-34, CONNAUGHT CIRCUS, NEW DELHI

,110001
NEW DELHI

Phone : 23723521
Email : nia.310300@newindia.co.in
Fax :

Collection Number : 31030081160000094981


Collection Date : 08/01/2017
Business Source Code : 2D10673292

Received with thanks from Biptom Bhowal .

The amount received/Adjusted is towards -


Policy No. A/C Description Amount` A/C Code Sub A/C Code
31030031160100089317 Bank-310300 1408.00 9100.310300 BA00002963-310300-9100

Total = ` 1408.00

Your Payment/Adjustment Details are as under -


Mode Amount ` Cheque Cheque Drawee Bank Drawee Reference No. Scroll/BG/
No. Date Branch APD
Balance
ECS 1408.00 HUBI50 N.A. N.A. N.A. 3103001622610132 N.A.
3256
4707

Total = ` 1408.00

Utilization details of the Collected Amount :


Premium Service Tax Stamp Duty Excess Amount
1224.00 184.00 0.00 0
Sl no. Agency Code Agency Name Department Code
1 NA NA 31

For The New India Assurance Company Limited

Revenue Stamp
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Date of Issue: 08/01/2017

(Mr Hemendra
Swaroop)
[SRDivisional Manager]

Cashier's Initial Authorized Signatory

NIA S.T.REGN No: AAACN4165CST178.


Signature Not
Verified
Digitally signed
by Srinivasan
Vaideswaran
Date: 2017.01.08
15:15:15 IST
Policy No. : 31030031160100089317Document generated by Policy Bazaar at 08/01/2017 15:15:13 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.
(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. : 31030031160100089317Document generated by Policy Bazaar at 08/01/2017 15:15:13 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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