RECEIPT IN FULL BY AGENT
Payment Date:
Payment Mode:
Cash:
Total Amount in Words:
Reference:
Address:
Sn No description of product Price Amount
Net Total:
Authorized Signature Customers Signature
Payment Date:
Payment Mode:
Cash:
Total Amount in Words:
Reference:
Address:
Sn No description of product Price Amount
Net Total:
Authorized Signature Customers Signature