RENEWAL PREMIUM RECEIPT

Voucher No 56368778

Voucher Date 13-May-2017

Policy Number 02164598

Name of Proposer D Ramanjula Naidu

Client ID 54134524

Mode of Payment Credit Card

Cheque No./Bank A/C No.

Bank Name CREDIT CARD

Amount 64263

Sig n a tu re N o t V er if ied

D ig i t al ly sig n e d b y A N EE L A S IN H A
D a t e: 2 017 . 0 5 .13 1 2: 25 : 28 + 0 5 :3 0

Mudrank No: EMSHU-2017 /1013/CR191/M1 Dated 16-05-2017 Authorised Signatory

Please Note:

1. This receipt is issued subjected to realization of cheque.

2. For any clarification, kindly contact our customer care centre (1800 209 8800).

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