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

Duplicate Receipt(Customer Copy)

Receipt No.

: NOC/16/1321818

Receipt Date:

5/27/2016 1:15:44 PM

Mode of Payment

: Axis IVR

Collection Date :

5/27/2016 1:15:44 PM

Received With Thanks From : SUMIT RAJ

Amount

: 5796

Amount in Words

: Rs. Five Thousand Seven

Hundred and Ninety Six Only

SNo.

Customer Id

Application No.

Amount

0000369598

1200578

5796

Pan No.

: AAFCM7916H

Service Tax No.

: AAFCM7916HST001

Issuing Office: Corporate office, Saket

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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