American Life Insurance Company

(Incorporated in USA,Nepal Regn.No 6/062/063)

Premium Receipt

Head Office in Nepal:

Narayani Complex, Pulchowk, Lalitpur,
PO Box: 11590
Toll Free: 1660-01-55555 (NTC)
Control No.: MET161020-00216
service-nepal@metlife.com.np
www.metlife.com.np

Received : NPR 25743.00

Policy Number : UL119221
On Account of : PREMIUM PAYMENT
Due Date : 23/08/2020
Payment Method : ONLINE PAYMENT
Payment Date : 16/10/2020
Policy Owner's ADHIKARI, PRAKASH
: Next Due Date : 23/08/2021
Name CHANDRA

Agency/Financial Associate Code: 069099105

This is a computer generated receipt issued by American Life Insurance Company (MetLife) and does not require any signature. Should the Policy is restored at any time by
acceptance of premium after the same is due and payable, such restoration shall not create an obligation or precedence for waiving any conditions of the policy in regard to
subsequent non-payment of any premium on the day it falls due. No person except an officer of MetLife as designated in the Policy is authorized to make, alter or discharge
contracts or waive forfeitures. If the said amount is not accepted by MetLife for the purpose offered, it will be returned to the depositor in usual course of business.