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[[preprinted]]No. 109
[[underlined]]RECEIPT FOR SENDER.[[/underlined]]
Date Stamp of Office of Posting 
[[stamped]] [[illegible]] [[/stamped]]

If a parcel { Weight (in tolas)} _________
              when not insured } (In words)

            { Postage (including _________
              registration fee)  Rs. / AS. 

[[boxed]]
To be filled up only in the case of
insured articles.

Insured for Rs (in figures)____          
(In words)_______________

Insurance fee Rs.___ AS. ____

Weight (in words)} RATES/TOLAS 
[[/boxed]]
N.B.-When the article is not to be insured the above should be crossed out by means of two diagonal lines. 
^[[initials]]Initials of Receiving Officer

Received a registered* ^[[Rh]]
addressed to ^[[Onst T Johnson]]
Post-town of destination ^[[Roxbury]]

*Write here "letter,""postcard,""packet,"or"parcel" as the case may require, with the word "insured" before it if the article is to be insured

Notice (1)—The Post Office is not responsible for loss or damage in the case of inland registered articles, unless they are also insured.
       (2)—The special conditions and restrictions as to insurance, which will be found in the current edition of the Indian Postal Guide, are binding upon every sender of an insured postal article by virtue of rules prescribed under the Indian Post Office Act, 1898.
[[/preprinted]]