………………

Date

……………………
Rs . ……………….
Three months after date, pay to A B, etc. or order Rs . …………………………… (Rupees …………
only) for value received.

X (Stamp)
(Drawer)
(Signature across the stamp)

To
………………………(Drawee)
In case of need
……………………….
…………………..Branch, Bombay.