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Date

Rupees
Received from
The sum of ₹
Duration
Full Amt. Due:
Stipulations

Recipient
Contact Info

Recipient Name & Sign


Giver Name & Sign

Evidence

1. Name : Signature

2. Name : Signature

Date
Rupees
Received from
The sum of Duration ₹
Full Amt. Due:
Stipulations

Recipient
Contact Info

Recipient Name & Sign


Giver Name & Sign

Evidence

1. Name : Signature

2. Name : Signature

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