Bajaj Allianz General Insurance Company Ltd.

12th Floor, Dr. Gopaldass Bhawan, 28, Barakhamba Road, Connaught Place, New Delhi - 110001
Contact No: 41490500/41490573/41490588/509/560; Fax No: 91-11-41490511

RECEIPT

Receipt Number 1101-01135196

Receipt Date 06/09/2020
Business Channel ML

Received with thanks from JITENDER KUMAR

(Intermediary Code : 10049023 ) a total sum of Rupees Fifteen Thousand One Hundred Only
by,

Instrument Inst./Ref No Instrument Bank Name Branch Name Amount

Type Date
Credit Card 13847292 06/09/0020 15,100

Total Amount Rs. 15,100.00

Note : RECEIPT CREATED THROUGH BFL-
Issuance of this receipt does not amount to acceptance of the risk by Bajaj Allianz General In-
surance Company Limited. The insurance cover for the risk shall be as per the terms and con-
ditions of the Insurance Policy if and when issued.
* Cheque/DD/PO receipt is valid subject to realisation of the instrument.

Consolidated Stamp Duty of Rs. 1 paid towards Revenue Stamps vide Challan No
MH008744978201920M defaced number 0004733383201920 dated 26-NOV-19 timing
13:00:00 of General Stamp Office, Mumbai, India

This is a computer generated document,hence does not require any signature.

Regd.Office: Bajaj Allianz House, Airport Road, Yerawada, Pune, Maharashtra 411006
CIN:U66010PN2000PLC015329; E-mail: bagichelp@bajajallianz.co.in; Website:www.bajajallianz.com