ACKNOWLEDGEMENT

Received a cheque bearing No.____________________ dated________________

amounting to Rs.______________ (Rupees___________________________________________

of ____________________________ for ___________________________________________

as Medical Loan with thanks.

2. I further declare that I will refund the amount of Medical Loan Rs.____________

(Rupees___________________________________________________ in lump sum within

three months from the date of receiving of cheque. In case of non-payment the amount of

medical loan within three months, a disciplinary action may initiate against me including

recovery from my salary.

Receivers Signature & Date__________________

Name __________________________________

Father’s Name __________________________

CNIC _________________________________

Rank___________________________________

Membership No._________________________

Place of Posting__________________________

Contact No.______________________________