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PREMIUM RECEIPT
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PROPOSER ADDRESS ISSUING OFFICE ADDRESS
Customer Id: 23057585680 DO 14 MUMBAI ., MUMBAI SAMACHAR MARG,
Customer Name: PANKAJ KUMAR MUMBAI-400001
MEHARMIAN PATTI, VPO SAMADH BHAI, MOGA, PUNJAB City : MUMBAI District : MUMBAI
City : Moga District : MOGA State : MAHARASTRA Pincode : 400001
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State : PUNJAB Pincode : 142057
. Office GSTIN No:27AAACU5552C1ZJ
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BUSINESS CHANNEL DETAILS
. . . .
Business Channel Code: 25391 Business Channel Sub Code: AGI0064124
. . . .
Mobile No: 9920320172 Agent Name : MAHESHWAR N.
. . .
Agent Email: BEHERA
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Received with thanks from PANKAJ KUMAR a sum of Rs. 51345.0 (RUPEES FIFTY ONE THOUSAND THREE HUNDRED
FORTY FIVE ONLY) as per details given hereunder
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. . .
Premium Amount Rs. 43513.0
. . .
IGST (18.0%) Rs. 7832.0
. . .
Total Premium Amount Rs. 51345.0
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SAC Code 9971
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Collection Number 10200010019107879749
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Collection Date 14/12/2019
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Payment Mode CREDIT CARD/NEFT-RTGS
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1. Receipt valid subject to realization of CREDIT CARD/NEFT-RTGS
2. Warranted that in case of non- realization of CREDIT CARD/NEFT-RTGS Policy and Receipt stands
cancelled automatically ab initio.
3. Please quote Customer Id, Receipt No. and Receipt Date in all correspondences
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Policy stamp defaced and retained at office For United India Insurance Company Limited
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Client IP Address : 10.95.22.1

Print date & time: 14/12/2019 12:26:00 pm

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Duly Constituted Attorneys

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This receipt is computer generated and does not require any seal or signature in original.
* This is a system generated document and any manual alteration / correction / overwriting in the document will make it invalid.

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