8/12/2019 116494880 Premium Pay Receipt1

1/1

RENEWAL PREMIUM RECEIPT

Rupees Five Thousand Eight Hundred And Twenty i! "n#y $%

Suvidhaa thanks you for using our services. For any queries please contact Suvidhaa call center at 022-

6715!22"225225.

1. Suvidhaa is #uthori$ed pre%iu% collection agent on &ehalf of '() and does not &ear any lia&ilities andconsequences there on arising out of lapse ! late pay%ent &y policy holder or any other losses.

2. *olicyholders are requested to check policy holder na%e+ policy no.+ date and ti%e of pay%ent and a%ount

&efore leaving the pay%ent counter. Suvidhaa shall not receive any co%plaint for any act!%istake!o%ission

later.

". 'ia&ility for any other act!%istake!o%ission!co%%ission ,if ad%issi&le of Suvidhaa shall &e li%ited up to the

pre%iu% a%ount of disputed policy.

N" ER&ICE CHAR'E F"R PA(IN' PREMIUM AT U&I)HAA P"INT*

uvidhaa Custo+er Care, -./%.001%002%002

)ollecting )enter Suvidhaa (nfoserve *vt. 'td.

Suvidhaa /iosk )ode 1726

eceipt 3o. 14467

ate ,i%e 24!07!201" 111210 #

Suvidhaa ef. 3o. 1164402407201"

Pay+ent Mode ,Cash

ranch )ode )/1

*))+ 3et8ork 9perating )entre+1st Floor+ :eevan Seva #nne;e+S.1-022-1251?

@%ail &oAc&k1Blicindia.co%?

eceived 8ith thanks s 5426 through ,singh co%%unication+ Suvidhaa (nfoserve *vt. 'td. fro%

policy holder Shri!S%t.CritunDai /u%arC to8ards the follo8ing policy!ies

Sr. 3o.*olicy 3o.

Short 3a%eServ. rn.

(nst.*re%.,s

ode

ue Fr

ue o

3o. of (nst.

otal *re%. ,s.

'ate Fees

otal #%ount

*lan

er%3e;t ue

1.116440/u%ar

1175426.06

24!07!201"24!07!201"

15426.0

0.05426

24!01!201

*age total 5426

Erand total 5426

Mudran3 Nu+4er , A*Mu*h*05/1$C*R*6.$M%/ )ated 5/$51$05/1

7ignature o8 uvidhaa 9ios3 Ho#der:

;indagi 9e aath