Max Bupa Health Insurance Company Limited

Regd. Office: Max House, 1 Dr Jha Marg, Okhla, Phase-III, New Delhi - 110020
Corporate Office: B-1/I-2, Mohan Cooperative Industrial Estate,Mathura Road, New Delhi-110044

Premium Receipt(Customer Copy)

Receipt No. : NOC/21/12078923 Receipt Date: 03/08/2023 04:54:21 PM

Mode of Payment : Online Payment Collection Date : 03/08/2023 04:54:21 PM
Received With Thanks From : Ramulu T
Amount : 55840
Amount in Words : Rs. Fifty five thousand eight hundred and forty Only
SNo. Customer Id Application No. Amount (Inclusive of GST @18%)
1 8000156783 1636372 55840
Pan No. : AAFCM7916H
GSTIN : 07AAFCM7916H1ZA
Issuing Office / State Code: Corporate Office, Mohan Estate / 7

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: Max House, 1 Dr Jha Marg, Okhla, Phase-III, New Delhi - 110020
Corporate Office: B-1/I-2, Mohan Cooperative Industrial Estate,Mathura Road, New Delhi-110044

Premium Receipt(Office Copy)

Receipt No. : NOC/21/12078923 Receipt Date: 03/08/2023 04:54:21 PM

Mode of Payment : Online Payment Collection Date : 03/08/2023 04:54:21 PM
Received With Thanks From : Ramulu T
Amount : 55840
Amount in Words : Rs. Fifty five thousand eight hundred and forty Only
SNo. Customer Id Application No. Amount (Inclusive of GST @18%)
1 8000156783 1636372 55840
Pan No. : AAFCM7916H
GSTIN: : 07AAFCM7916H1ZA
Issuing Office / State Code: Corporate Office, Mohan Estate / 7
SAC Code/Type of Service: 997133/General Insurance Services