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Your Company Name

Uni.Asia General Insurance Berhad Phone: 03-2693 2893


10th Floor, Menara Uni.Asia Fax: 03-2693 2893
1008, Jalan Sultan Ismail E-mail: callcentre@uniasiageneral.com.my
50250 Kuala Lumpur
Statement
Statement #: 76543-1A Bill To: Merpati Enterprise
Date: December 8, 2021 Level 2, Department 7,
Customer ID: 45A68-3 Wisma MPL
Jalan Raja Chulan
50250 Kuala Lumpur

Date Type Invoice # Description Amount Payment Balance

Reminder: Please include the statement number on your check. Total $ -


Terms: Balance due in 30 days.

REMITTANCE

Customer Name: Enter customer name


Customer ID: 45A68-3
Statement #: 76543-1A
Date: December 8, 2021
Amount Due: $0.00
Amount Enclosed:

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