……………………

Date …………….

Rs …………………
On demand, we hereby promise to pay to X Y, son of……………………resident of
………………or order the sum of Rs ……………….(Rupees…………….only)
Name and address of drawers
1 .
2.
3.

……………………….(Stamp)
…………………………
…………………………
Drawers
(Signatures across the stamp)