Max Bupa Health Insurance Company Limited

Regd. Office: C-98, Lajpat Nagar 1, Delhi-110024

Corporate Office: 14th Floor, Capital Cyberscape, Golf Course Extension Road, Sector-59, Gurugram-122011 (Haryana)

Duplicate Temporary Receipt(Customer Copy)

Receipt No. : NOCNOD/21/1325035 Receipt Date : 09/05/2021 2:08:46 PM

Mode of Payment : Online Payment Collection Date : 09/05/2021 2:08:46 PM
Received With Thanks From : niklesh chandak
Amount : 26394
Amount in Words : Rs. Twenty Six Thousand Three Hundred and Ninety Four Only
SNo. Customer Id Application No. Amount (Inclusive of GST @18%)
1 2001270259 81100298222 26394
Pan No. : AAFCM7916H
GSTIN : 09AAFCM7916H1Z6
Cust GSTIN No :
Issuing Office / State Code: NOC NOIDA / 9
SAC Code/Type of Service: 997133/General Insurance Services
Disclaimer:-
1) The receipt is subject to Realisation of cheque. Max Bupa Health Insurance Company reserves the right to cancel the contract without giving any further notice in case the cheque is dishnoured.
2) Acceptance of premium do not constitute acceptance of risk. Commencement of risk is subject to technical clearance and acceptance by Underwriting Team of Max Bupa Health Insurance Company Limited.
3) In case of non acceptance/rejection of proposal by the Company on technical grounds, premium deposited will be refunded without interest.

This is a computer generated receipt, does not require any signatures

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Max Bupa Health Insurance Company Limited

Regd. Office: C-98, Lajpat Nagar 1, Delhi-110024
Corporate Office: 14th Floor, Capital Cyberscape, Golf Course Extension Road, Sector-59, Gurugram-122011 (Haryana)

Duplicate Temporary Receipt(Office Copy)

Receipt No. : NOCNOD/21/1325035 Receipt Date : 09/05/2021 2:08:46 PM

Mode of Payment : Online Payment Collection Date : 09/05/2021 2:08:46 PM
Received With Thanks From : niklesh chandak
Amount : 26394
Amount in Words : Rs. Twenty Six Thousand Three Hundred and Ninety Four Only
SNo. Customer Id Application No. Amount (Inclusive of GST @18%)
1 2001270259 81100298222 26394
Pan No. : AAFCM7916H
GSTIN: : 09AAFCM7916H1Z6
Cust GSTIN No :
Issuing Office / State Code: NOC NOIDA / 9
SAC Code/Type of Service: 997133/General Insurance Services