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GOLD LOAN SHOP

123, Main Street, City Name, State - 123456

Phone: 9876543210

Receipt No:4
Date:05-03-2026
Loan Amount:₹ 200,000.00
Customer ID:1
Name:sannasi
Mobile:9898987987979
Address:fdd, dfdg, fdghd, dfgd, dfgdg, sdg, 600000
Pledged Items
S.No Item Name Gross Wt (g) Deduction (g) Net Wt (g) Photo
1 Ring 10.000 1.000 9.000
2 stud 0.000 0.000 0.000 -
3 jhguj 0.000 0.000 0.000 -

Amount in Words: Two Lakh Rupees

Interest Rate: 2.00% per month

Due Date: 05-03-2027



_________________________

Customer Signature



_________________________

Authorized Signatory

Subject to City Jurisdiction. Interest calculated monthly.

GOLD LOAN SHOP

123, Main Street, City Name, State - 123456

Phone: 9876543210

Receipt No: 4
Date: 05-03-2026
Amount: ₹ 200,000.00
Cust ID: 1
Name: sannasi
Mobile: 9898987987979
Item G.Wt N.Wt Photo
Ring 10.000 9.000
stud 0.000 0.000 -
jhguj 0.000 0.000 -

____________

Customer


____________

Signatory

GOLD LOAN SHOP

123, Main Street, City Name, State - 123456

Ph: 9876543210

Rcpt #: 4 Date: 05-03-2026

Name: sannasi

Mobile: 9898987987979

Address: fdd, dfdg, fdghd, dfgd, dfgdg, sdg, 600000...

Amount: ₹ 200,000.00

Interest: 2.00%

Words: Two Lakh Rupees

Pledged Items
Item G.Wt N.Wt Photo
Ring 10.000 9.000
stud 0.000 0.000 -
jhguj 0.000 0.000 -

__________________

Customer Sig

__________________

Auth Signatory

GOLD LOAN SHOP
9876543210
Rcpt: #4 05-03-26
Cust: sannasi
Mob: 9898987987979
Item
GW
NW
Ring
10.000
9.000
stud
0.000
0.000
jhguj
0.000
0.000
Loan Amt: ₹ 200,000.00

Thank You!