Niva Bupa Health Insurance Company Limited

(formerly known as Max Bupa Health Insurance Co. Ltd.)

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/22/1198740 Receipt Date : 8/2/2022 6:01:41 PM

Mode of Payment : Online Payment Collection Date : 8/2/2022 6:01:41 PM
Received With Thanks From : ASHOK KUMAR JAIN
Amount : 32202
Amount in Words : Rs. Thirty Two Thousand Two Hundred and Two Only
SNo. Customer Id Application No. Amount (Inclusive of GST @18%)
1 2000218001 810000153460 32202
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) Niva Bupa Health Insurance Company Limited (formerly known as Max Bupa Health Insurance Co. Ltd.) The receipt is subject to realization of cheque. Niva Bupa Health Insurance Company Limited reserves the right
to cancel the contract without giving any further notice in case the cheque is dishonored.
2) Acceptance of premium do not constitute acceptance of risk. Commencement of risk is subject to technical clearance and acceptance by Underwriting Team of Niva 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.

------------------------------------Tear From Here------------------------------------------------------------------------

Niva Bupa Health Insurance Company Limited

(formerly known as Max Bupa Health Insurance Co. Ltd.)
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/22/1198740 Receipt Date : 8/2/2022 6:01:41 PM

Mode of Payment : Online Payment Collection Date : 8/2/2022 6:01:41 PM
Received With Thanks From : ASHOK KUMAR JAIN
Amount : 32202
Amount in Words : Rs. Thirty Two Thousand Two Hundred and Two Only
SNo. Customer Id Application No. Amount (Inclusive of GST @18%)
1 2000218001 810000153460 32202
Pan No. : AAFCM7916H
GSTIN: : 09AAFCM7916H1Z6
Cust GSTIN No :
Issuing Office / State Code: NOC NOIDA / 9
SAC Code/Type of Service: 997133/General Insurance Services