FAIRFIRST INSURANCE LIMITED
(Company No. PB 5180)
Access Towers II (14th Floor),
278/4, Union Place, Colombo 02, Sri Lanka
Tel : 011-2428428 (Customer Service) 011-2428000 (General Line)
Debit Note
INSURER'S VAT REGD NO : 139051807-7000 DEBIT/CREDIT NOTE NO : CRATS2400191180000001
INSURER'S SVAT REGD NO : SVAT007260 INSURED'S VAT REGD NO :
INSURER'S NBT REGD NO : 134008202-9000 INSURED'S SVAT REGD NO :
ISSUE DATE : 01/12/2024 ISSUE TIME : 6:10:42 PM
NAME : MR MOHAMED HAAZIM MOHAMED IQBAL
ADDRESS : FRANCEWATTE, MATTAKKULIYA NO.68/1,THEWATTA ROAD,RAGAMA 112957357.
COLOMBO 15
SRI LANKA
RENEWAL/ENDT.
POLICY NO UW YEAR BROKER/AGENT SALES EXECUTIVE BRANCH SI - (USD)
NO
CRATS240019118 2024 00/000 TA000002 TK001500 HEAD OFFICE 50,000.00
PREMIUM SUMMARY AMOUNT (LKR)
PREMIUM (W/O RS & TC) 14,006.36
POLICY FEE 350.00
STAMP DUTY 15.00
CESS 42.01
ADMIN FEE (INCLUSIVE OF SSCL) 368.98
VAT @ 18 % 2,660.82
TOTAL PREMIUM PAYABLE 17,443.17
CHEQUES SHOULD BE DRAWN IN FAVOUR OF FAIRFIRST INSURANCE LIMITED AND CROSSED A/C PAYEE ONLY.
PLEASE REFER PREMIUM PAYMENT WARRANTY ATTACHED TO THE POLICY REGARDING PREMIUM PAYMENT.
ON PAYMENT, PLEASE ENSURE THAT AN OFFICIAL RECEIPT SIGNED BY THE CASHIER OF THE COMPANY IS OBTAINED.
IF YOU ARE A VAT REGISTERED PERSON PLEASE SUBMIT THE VAT NUMBER WITHIN 14 DAYS OF ISSUE OF THIS DEBIT NOTE.
THIS IS A COMPUTER GENERATED DOCUMENT. NO SIGNATURE IS REQUIRED.
EXECUTED AT : HEAD OFFICE
FAIRFIRST INSURANCE LIMITED
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TEL: 011-2428428