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/23/1306728 Receipt Date : 4/2/2023 8:52:19 PM

Mode of Payment : PayU-Online Collection Date : 4/2/2023 8:52:19 PM
Received With Thanks From : SUJAN N
Amount : 30850
Amount in Words : Rs. Thirty Thousand Eight Hundred and Fifty Only
SNo. Customer Id Application No. Amount (Inclusive of GST @18%)
1 5000025674 810000792508 30850
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.

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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/23/1306728 Receipt Date : 4/2/2023 8:52:19 PM

Mode of Payment : PayU-Online Collection Date : 4/2/2023 8:52:19 PM
Received With Thanks From : SUJAN N
Amount : 30850
Amount in Words : Rs. Thirty Thousand Eight Hundred and Fifty Only
SNo. Customer Id Application No. Amount (Inclusive of GST @18%)
1 5000025674 810000792508 30850
Pan No. : AAFCM7916H
GSTIN: : 09AAFCM7916H1Z6
Cust GSTIN No :
Issuing Office / State Code: NOC NOIDA / 9
SAC Code/Type of Service: 997133/General Insurance Services