1. Asia Insurance Corporation
No: 32 , Barly _____ Tipe Road
Green Path
Colombo – 03
RECEIPT
RENEWAL
(THIS IS NOT A TAX INVOICE)
Insured Name & Addess Receipt No : KU00008R64
Mrs. H.M.T Menike Copy : CUSTOMER COPY
Herath Stores , koswatta Date : 02/12/2012
Panadaragama Time : 10.45 AM
Department : KURUNAGALA
POLICY NO : 97KUD666675 Buss. Class : MOTOR
ENDORSMENT NO : KU00008154567 Policy Type : HIRING VEHICLE
Init Sum Insured : Rs. 1,000,000.00 Effect Date : 05/12/2012
New Sum Insured : Rs. 900,000.00
Period of Cover : 05/04/2012 – 04/04/2013
Risk Refference : 48-2264
Particulars Amount (Rs.)
PREMIUM EXCLUDING SRCC / TC 8,717.50
SRCC PREMIUM 1,000.00
POLICY FEE 200.00
Total Excluding Levies 9,717.50
Other Levies 1462.62
Admin Fee 33.31
Total Includin Levies 11,213.43
Received with thanks a sum of srilankan Rupees. Eleven thousend two hundred
and thirteen and cents forty three only
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Prepared By Checked By Authorised by Cashier Signature
Subject to realiztion of the cheque