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I hereby acknowledgement that a sum of Rs………………………./-

(Rupees in word…………………………………………………………………………………………..)

Is due from me to Shri/ Mr/ Mrs/Miss…………………………………………………………………….

S/o……………………………………………………………………………………………………………

R/o……………………………………………………………………………………………………………

S/d……………………………………………………….

S/o. Shri…………………………………………………

Amount: Date:
Place:

I,______________(Name), make commitment to pay _______(Name of the company), the sum of Rs. ________. Repayment is to be made in the

(Company’s Name)
(Company’s Address)
( contact Number, Email)

Name of Receiptent:____________________
Address:__________________________
Contact number:____________________

Particulars Description Quantity Amount

Grand total: