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    Mediclaim Format 1

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    Urvashi Jain
    Niva Bupa Health Insurance Company Limited provided a temporary receipt to Urvashi Jain for an online payment of Rs. 32,202 towards health insurance application number 810000253431. The receipt included details of the payment such as receipt number, date, payment mode, amount, applicable GST, and disclaimers regarding acceptance of risk and refund of premium in case of non-acceptance.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Mediclaim Format 1

    Uploaded by

    Urvashi Jain
    242 views1 page
    Niva Bupa Health Insurance Company Limited provided a temporary receipt to Urvashi Jain for an online payment of Rs. 32,202 towards health insurance application number 810000253431. The receipt included details of the payment such as receipt number, date, payment mode, amount, applicable GST, and disclaimers regarding acceptance of risk and refund of premium in case of non-acceptance.

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    Niva Bupa Health Insurance Company Limited provided a temporary receipt to Urvashi Jain for an online payment of Rs. 32,202 towards health insurance application number 810000253431. The receipt included details of the payment such as receipt number, date, payment mode, amount, applicable GST, and disclaimers regarding acceptance of risk and refund of premium in case of non-acceptance.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    242 views1 page

    Mediclaim Format 1

    Uploaded by

    Urvashi Jain
    Niva Bupa Health Insurance Company Limited provided a temporary receipt to Urvashi Jain for an online payment of Rs. 32,202 towards health insurance application number 810000253431. The receipt included details of the payment such as receipt number, date, payment mode, amount, applicable GST, and disclaimers regarding acceptance of risk and refund of premium in case of non-acceptance.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Niva Bupa Health Insurance Company Limited

    (formerly known as Max Bupa Health Insurance Co. Ltd.)


    Regd. Office: C-98, Lajpat Nagar 1, Delhi-110024
    Corporate Office: 14th Floor, Capital Cyberscape, Golf Course Extension Road, Sector-59, Gurugram-122011 (Haryana)

    Duplicate Temporary Receipt(Customer Copy)

    Receipt No. : NOCNOD/22/1138721 Receipt Date : 9/21/2022 6:01:41 PM


    Mode of Payment : Online Payment Collection Date : 9/21/2022 6:01:41 PM
    Received With Thanks From : Urvashi Jain
    Amount : 32202
    Amount in Words : Rs. Thirty Two Thousand Two Hundred and Two Only
    SNo. Customer Id Application No. Amount (Inclusive of GST @18%)
    1 2001218001 810000253431 32202
    Pan No. : AAFCM7916H
    GSTIN : 09AAFCM7916H1Z6
    Cust GSTIN No :
    Issuing Office / State Code: NOC NOIDA / 9
    SAC Code/Type of Service: 997133/General Insurance Services

    Disclaimer:-
    1) Niva Bupa Health Insurance Company Limited (formerly known as Max Bupa Health Insurance Co. Ltd.) The receipt is subject to realization of cheque. Niva Bupa Health Insurance Company Limited reserves the right
    to cancel the contract without giving any further notice in case the cheque is dishonored.
    2) Acceptance of premium do not constitute acceptance of risk. Commencement of risk is subject to technical clearance and acceptance by Underwriting Team of Niva 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.

    ------------------------------------Tear From Here------------------------------------------------------------------------

    Niva Bupa Health Insurance Company Limited


    (formerly known as Max Bupa Health Insurance Co. Ltd.)
    Regd. Office: C-98, Lajpat Nagar 1, Delhi-110024
    Corporate Office: 14th Floor, Capital Cyberscape, Golf Course Extension Road, Sector-59, Gurugram-122011 (Haryana)

    Duplicate Temporary Receipt(Office Copy)

    Receipt No. : NOCNOD/22/1138721 Receipt Date : 9/21/2022 6:01:41 PM


    Mode of Payment : Online Payment Collection Date : 9/21/2022 6:01:41 PM
    Received With Thanks From : Urvashi Jain
    Amount : 32202
    Amount in Words : Rs. Thirty Two Thousand Two Hundred and Two Only
    SNo. Customer Id Application No. Amount (Inclusive of GST @18%)
    1 2001218001 810000253431 32202
    Pan No. : AAFCM7916H
    GSTIN: : 09AAFCM7916H1Z6
    Cust GSTIN No :
    Issuing Office / State Code: NOC NOIDA / 9
    SAC Code/Type of Service: 997133/General Insurance Services

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