PAYMENT ADVICE

HDFC ERGO GENERAL INSURANCE COM LTD

MUM
MUM
MAHA

To : Gopal Lal Jangid

Address : Dharmpura Badapadampura Chaksu
,,Rajasthan,
,,,,303903 ,7891234566

Bene Code : R-HS21-12426273 Our Ref : 00000000003001177566

Bene Name : Gopal Lal Jangid

Credit A/c No. : 05152010001100 Your Ref:3001177566

Chq /DD/Ft No : N187211555973529 Value Date :05/07/2021
Amount : 126632.00
Amount In Words : Rupees One Lakh Twenty Six Thousand Six Hundred Thirty Two And
Paise Zero Only
Bank Ref No : N187211555973529

Dear Sir/Madam,

We have initiated a credit to the Account Number 05152010001100 with PUNJAB NATIONAL
BANK with an IFSC Code PUNB0051510 through NEFT mode.

As Per The details are given below:

________________________________________________________________________________
|Policy No | 4848100228840502000|Claim No | RR-HS21-12426273|
________________________________________________________________________________
|PAY_TYPE | Loss Paid|PAYEE CODE| A10012389564|
________________________________________________________________________________
|GROSS AMT | 126632|TPA CLAIM NO| RR-HS21-12426273|
________________________________________________________________________________
|Add : TAX | |PRODUCT TYPE| Easy Health|
________________________________________________________________________________
________________________________________________________________________________
00000000003001177566 06/07/2021 Page 1 of 1
________________________________________________________________________________

This is Computer generated advice & Does not require any signature.
 Page# 2
Address : Dharmpura Badapadampura Chaksu
,,Rajasthan,
,,,,303903 ,7891234566

Bene Code : R-HS21-12426273 Our Ref : 00000000003001177566

Bene Name : Gopal Lal Jangid

Credit A/c No. : 05152010001100 Your Ref:3001177566

Chq /DD/Ft No : N187211555973529 Value Date :05/07/2021
Amount : 126632.00
Amount In Words : Rupees One Lakh Twenty Six Thousand Six Hundred Thirty Two And
Paise Zero Only
Bank Ref No : N187211555973529

Dear Sir/Madam,

We have initiated a credit to the Account Number 05152010001100 with PUNJAB NATIONAL
BANK with an IFSC Code PUNB0051510 through NEFT mode.

As Per The details are given below:

|Less : TDS | 0|BUSINESS TYPE| Renewal|

________________________________________________________________________________
|NET_PAY | 126632|
________________________________________________________________________________
________________________________________________________________________________
00000000003001177566 06/07/2021 Page 2 of 1
________________________________________________________________________________

This is Computer generated advice & Does not require any signature.