THE NEW INDIA ASSURANCE CO. LTD.

(Wholly owned by the Govt. of India)

COLLECTION RECEIPT CUM ADJUSTMENT VOUCHER

Issuing Office
Address

: BALANAGAR BO (611702)
: 3-51/3, I FLOOR, RAGHAVENDRA MANSION, OPP. H.A.L.GATE, HYDERABAD-500042
Hyderabad

Phone
Email
Fax

: 04023774483
: nia.611702@newindia.co.in
: 04023772661

Collection Number
Collection Date
Business Source Code

: 10000089140100086729
: 17/01/2015
: 1D4316397

Received with thanks from BINOY PASWAN ..

The amount received/Adjusted is towards Policy No.
A/C Description
61170231140200004674
Bank-100000

Amount`
578.00

A/C Code
9100.100000

Sub A/C Code

BA00013647-100000-9100

Total = ` 578.00
Your Payment/Adjustment Details are as under Mode
Amount ` Cheque
Cheque
No.
Date
EPG
Credit
Advice

578.00

QR104
26588

N.A.

Drawee Bank

Drawee
Branch

N.A.

N.A.

Reference No.

6117021410013103

Scroll/BG/
APD
Balance
N.A.

Total = ` 578.00
Utilization details of the Collected Amount :
Premium
Service Tax
514.00
64.00
Sl no.
Agency Code
1
1D4314617

Stamp Duty
0.00

Excess Amount
0
Department Code
31

Agency Name
MR. C MANOHAR REDDY

For The New India Assurance Company Limited

Revenue Stamp
__________
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Cashier's Initial

Authorized Signatory

NIA S.T.REGN No: AAACN4165CST178.

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.
Signature Not
Verified

Digitally signed
by Srinivasan
Vaideswaran
Date: 2015.01.17 Policy
08:14:16 IST

No. : 61170231140200004674Document generated by QR_RENEWAL at 17/01/2015 08:14:15 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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