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    Discharge Voucher

    Uploaded by

    bajajjaikrishnaa2000

    Copyright:

    © All Rights Reserved
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    Discharge Voucher

    Uploaded by

    bajajjaikrishnaa2000
    41 views1 page

    Original Title

    Discharge-Voucher (1)

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    © © All Rights Reserved

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    41 views1 page

    Discharge Voucher

    Uploaded by

    bajajjaikrishnaa2000

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
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    THE ORIENTAL INSURANCE CO. LTD.

    Regd. Office: Oriental House, P.B.No. 7037, A-25/27, Asaf Ali Rd., Delhi – 110 002
    BROKER CELL , MRO III, TOWN CENTRE, TOWER -1, 6TH FLOOR, ANDHERI- KURLA
    ROAD, MAROL, ANDHERI (EAST), MUMBAI- 400 059.
    Contact :- 022 61493122 / 6149107 / 6149108

    DISCHARGE VOUCHER

    Dept: MISC Claim No.: To be filled by OneAssist


    Policy No.: To be filled by OneAssist
    Insured:
    Date of Loss:

    In consideration of approval of our claim we hereby accept from The Oriental Insurance Company
    Limited the sum of Rs........................ (Rupees _________________________________ only)
    (Approved Net Claim amount –To be kept blank) towards full and final settlement of Total /
    Partial claims in respect of Gadget …............................... IMEI No. ..........................

    We hereby voluntarily give discharge receipt to the Company in full & final settlement of all our
    claims present or future arising directly/indirectly in respect of the said loss/accident. We hereby
    also subrogate all my/our rights and remedies to the Company in respect of the above loss/damages.

    Rs. (To be kept blank)___________________________


    One rupee revenue
    stamp when claim amt.
    Exceeds Rs.5000/-

    Signature of Insured with seal :.......................... Signature of Benficiery :..........................


    Bank Name & Branch Address : ............................... Full name ............................................
    .................................................................................... Address .......................................................
    Account No....................................................
    IFSC CODE ................................... Tel.No........................................................
    Bank Name & Branch Address .... ..............
    Account No................................................
    IFSC CODE ..............................................
    Witness :
    Signature :
    Full Name :
    Address :
    Tel. No. :

    Consequent upon release of payment of Rs._____________ (To be kept blank) in respect of mobile
    IMEI no.________ , in favour of M/s. OneAssist Consumer Solutions Pvt Ltd, of claimant
    ________________ who in turn stands indemnified and that in future if any of the claimant and
    nominee or any other legal heir claims for the subject claim or raises an issue in respect thereof ,
    then M/s. OneAssist Consumer Solutions Pvt Ltd, who receives the payment in lieu of the said claim
    shall solely and fully be responsible & liable to make the payment to the claimant & or nominee or
    legal heir thereof including the litigation cost or any other liabilities arising out of the same.

    Authorised Signatory
    For M/s. One Assist Consumer Solutions Pvt Ltd

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