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STAMP RECEIPT

Tirupati,

Date: 16-02-2019.

Received a sum of Rs.12,000/- (Rupees Twelve Thousands only) from


M. Sathish, S/o G. Mani, D.No.83/C, K.T. Road, Tirupati with regard to vehicle
damage and that I have not sustained any injuries to my body and that the accident
as mentioned in Kararanama dated 16-02-2019 was caused due to my negligence
and that I will not claim any kind of compensation from M. Sathish in future as I
am only responsible for the above said accident as mentioned in Kararanama dated
16-02-2019.

Witness:
1)

2)

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