THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)
COLLECTION RECEIPT CUM ADJUSTMENT VOUCHER
Issuing Office : CITY DIVISIONAL OFFICE II (720200)
Address : 863, BIG BAZAAR STREET, COIMBATORE-1
,641001
COIMBATORE
Insured Pan Number :
Phone : 04222392548
Email : nia.720200@newindia.co.in
Fax : 04222396771
Collection Number : 72020081240000003337
Collection Date : 08/08/2024
Business Source Code : ML3657616
PAN No of Payer :
Received with thanks from RAJENDRAN G.
The amount received/Adjusted is towards -
Policy No. A/C Description Amount` A/C Code Sub A/C Code
72020031240100003234 Bank-720200 37540.00 9100.720200 BA00000177-720200-9100
Total = ` 37540.00
Your Payment/Adjustment Details are as under -
Mode Amount ` Cheque Cheque Date Drawee Bank Drawee Branch Reference No. Scroll/BG/A
No. PD Balance
Cheque 37540.00 373711 30-JUL-24 BANK OF INDIA COIMBATORE 7202002410010068 N.A.
BR CBE
Total = ` 37540.00
Utilization details of the Collected Amount :
Premium GST Stamp Duty Excess Amount
31814.00 5726.00 0.00 0
Sl no. Agency Code Agency Name Department Code
1 NA SAKTHI PELICAN INSURANCE BROKING PVT LTD., 31
For The New India Assurance Company Limited
Revenue Stamp
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Date of Issue: 08/08/2024
(Mr.
DAKSHINAMOORTHY
K)
[DIVISIONAL
MANAGER]
Cashier's Initial Authorized Signatory
Note -
1.Please note the Policy Number, Collection Number and date in all future correspondence.This Receipt is subject to Realisation of
Cheque..
Signature Not
Verified
Digitally signed
by DHIRAJ
KUMAR
Date: 2024.08.08
14:40:54 IST
Policy No. : 72020031240100003234Document generated by BR_0000725 at 08/08/2024 14:40:52 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.
(Government of India Undertaking)
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.
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.
Tax Invoice No : 72020024P0005894
IRDA Registration Number: 190
NIA PAN NUMBER: AAACN4165C
Policy No. : 72020031240100003234Document generated by BR_0000725 at 08/08/2024 14:40:52 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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