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RECEIPT
Receipt Number Receipt Date Business Channel 1814-00033870 05/04/2012 MD
(Customer ID : 43574209 ) a total sum of Rupees Nine Hundred Fifty Nine Only by,
Instrument No.
Instrument Date
Bank Name
Branch Name
Amount 959
Total Amount
Note : SC NO:17433648-10012147
Rs.
959.00
Issuance of this receipt does not amount to acceptance of the risk by Bajaj Allianz General Insurance Company Limited. The insurance cover for the risk shall be as per the terms and conditions of the Insurance Policy if and when issued. * Receipt Subject to realisation of cheque(s)
Authorised Signatory