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ntermediary, Cheque No. and Account Description
Sl. N( Tr.Cd. (eat Numbe
Customer/
Bank Name and
Date Narration Sub Acct Amount
Drawee Branch
Employee Name Rs Pr
RENEWAL NOTICE
To, From,
This is to remind you that your insurance policy mentioned below is expiring on og/L212o16. please
above actdress within the details of changes, if rny, we will advise you the correct premium payable contact us at an early date at the
continuit'/ of your insurance. by you well in advance to maintain
Authorised Signatory
To,
United India Insurance Company Limited MRS AYEETA BISWAS PAUL ( 23019985221
Issuing Office : O3O2OO )
SODEPUR ROAD, BADAMTALA, SHRIPUR, P.O. MADHYAMGRAM
38 B, I.IIMALAYA HOUSE
JAWAHARLAL NEHRU ROtrD, CHOWRINGHEE NORTH TWENTY FOUR PARGANAS-7OO13O
KOLKATA, KOLKATA, WEST BENGAL WEST BENGAL
KOLKATA-7OOO71 Mobile:9748444975
WEST BENGAL
Tr
Dear Sir/Madam,
with referr:nce to your renewal notice(s) please renew the policy o3o2oo2g15p1to7g3oi)5
herewith my cheque/DD/cash for T 12,0t,3.OO for further period of one year. I enclose
towards r-en"*ai premium,
Date :
Place :
Payment due on : 09/,12/2016
Pay by: 09/12/2016
Signature of Insured