Renued Insurance

HDFC ERGO General Insurance Company Limited
2952202472335301000
Mr Hridya Lal Prasad

Hno- 82 1St Floor Humayunpur Safdar Jung
Enclave Near N C C Gate 01 Mother Dairy Shop .
Delhi, 110029
Delhi
Contact No : 7838621737
Date : 15/10/2019
Dear Mr Hridya Lal Prasad
Thank you for choosing HDFC ERGO as your preferred insurance partner. We welcome you to be a part of our family !
Your Health insurance policy reference no 2952202472335301000 is confirmed on the basis of the information and declaration given by you.
The details of coverage are mentioned in the enclosed policy schedule of insurance.
We value your relationship with us and assure you our best services at all times and we look forward to serve you.
Now you can view your policy details and health card at your fingertips. Download our Mobile App now and experience convenience today!!
For HDFC ERGO General Insurance Company Ltd.
Ankur Bahorey
Head - Retail Business Group
HDFC ERGO General Insurance Company Limited 2952202472335301000
TAX CERTIFICATE
Dear MR HRIDYA LAL PRASAD
Subject : Certificate for the purpose of deduction under section 80 D of Income Tax (Amendment) Act, 1986
This i s to certify that we have received an amount of ` 15411 towards premium for Health Suraksha Policy and my:health Medisure Super Top Up Insurance, Policy
No. 2952202472335301000 issued to for the period 26/10/2019 to 25/10/2020.
Note : This is subject to the provisions of Section 80D of income tax (Amendment) Act, 1986 as amended from time to time.
This certificate must be surrendered to the company in case of cancellation of this policy. In event of incorrect representation of this declaration the liability shall be upon the policy
holder.
Date : 15/10/2019
Policy Issuing Office: Mumbai
Duly Constituted Attorney
HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 Customer Service Address: D 301, 3rd Floor,
CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078.
165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service No : +91 22-62346234/+91-120 6234 6234 | www.hdfcergo.com
POLICY SCHEDULE Health Suraksha Policy
SILVER PLAN
2952202472335301000
Policy No. :2952 2024 7233 5301 000 Issuance Date :15/10/2019
Period of Insurance :From 26/10/2019 00:01 hrs To 25/10/2020 Midnight
Invoice No. :202472335301000 Premium Frequency :Yearly
0
HSN Code :997133 Policy Type :Family Floater

Mr Hridya Lal Prasad Proposer Name :Mr Hridya Lal Prasad PAN
Hno- 82 1St FloorHumayunpur Safdar Jung EnclaveNear N
Customer Id :100356991909
C C Gate 01 Mother Dairy Shop .Delhi
Delhi, 110029, Contact No : 7838621737
Payment Details : ERGO_CC_15102019 , Date: 15/10/2019, Bank Name:HDFC Bank Ltd

Email ID : [email protected]
Insured Person’s Details & Sum Insured
Insured's Name Relationship Date of Birth Member ID 1st Policy Portability Pre Existing
Inception Sum Insured (`) Disease
Hridya Lal Prasad Self 30/12/1983 26/10/2018 NO

Sita . Wife 01/01/1983 26/10/2018 NO
Himanshu . Son 04/06/2008 26/10/2018 NO
Harshika . Daughter 23/11/2013 26/10/2018 NO
Sum Insured 300,000.00 CB Amount 15,000.00
In case of increase in the Sum Insured at renewal, waiting period will apply afresh in relation to the amount by which the Sum Insured has been enhanced.
Nominee Name Sita Relationship Spouse
The nominee must be an immediate relative of the Insured Person. For all other insured person(s), the Policyholder shall be the nominee.
Coverage Details
Coverage Details Coverage Details
In-Patient Treatment Covered Pre-hospitalization (days) 60
Post-hospitalization (days) 90 Day Care Procedures Covered
Domiciliary Treatment Covered Organ Donor Expenses Covered
Emergency Ambulance Charges (Limit per Ayurvedic /Unani/Sidha/ Homeopathic
Upto Rs. 2000 Covered
hospitalisation)
Health Check up per family (Post 4 Claims free Upto 1% Sum Insured,Maximum Upto Rs Hospital Daily Cash (only to the eldest member Rs.1000/- per day for a maximum of
years) 5000/- of the family) 30 days
The Policy Wording includes all the standard coverages offered b y the Company to its customers. Your entitlement for coverage/benefits shall be restricted to the coverage/benefits a s mentioned in this Policy
Schedule issued to you. Please read the Policy Wording in conjunction with the Policy Schedule. For any clarification, please call our toll free number.
Subject to the conditions laid down in the Policy, on completion of each four consecutive policy years with us, the eligible Insured Person(s), included in each policy year is/are entitled for a medical checkup benefit
up to an amount equals to 1% of sum insured or Rs 5000/- whichever is less.
Premium Details (`)
Basic Premium 9,650.00
Loadings 0.00
GST 18% : Central Tax 9% ( `868.5 ) + State Tax 9% ( `868.5) 1,737.00
Total Premium 11,387.00
For Claim/Policy related queries call us at +91- 22 6234 6234/+91- 120 6234 6234 or Visit Help Section on www.hdfcergo.com for policy copy/tax certificate/make changes/register & track claim.
If the premium is not realised the policy shall be void from inception.2004/4125/CR 690/M-1 GST Registration No: 07AABCL5045N1ZA. GST for this invoice is not payable under reverse charge basis.
Branch :unit no 502,504,506, 5th fl, mahatta tower 54, b-1 block, community centr west delhi Write to us : [email protected]
Agent Name :HDFC BANK LTD Agent Code :201587086428 Tel No. : 91-22-61606161
HDFC ERGO General Insurance Company Limited 4

Policy No.:2952202472335301000 This card is for identification purpose only.
Valid From: 26/10/2019 Renewal Date: 25 October
Card has to be presented to the Network Service Provider at the time of admission/ availing
Insured Name Date Of Birth Gender cashless hospitalization o r any other services. Insurance claim will be processed in accordance
sita . 01/01/1983 Female with the policy term & conditions. Card does not guarantee cashless hospitalization or any other
himanshu . 04/06/2008 Male service. For more details and updated list of Network Service Provider please refer our website or
harshika . 23/11/2013 Female call our call centre. This card is valid till the time policy is active.
HRIDYA LAL PRASAD 30/12/1983 Male
Customer Service No : 022 - 6234 6234 / 0120 - 6234 6234
Fax Number : 1860 2000 600
Email : [email protected]
Processing Centre : HDFC ERGO General Insurance Company Ltd. 5th floor,
Tower 1, Steller IT Park, C-25, Sector-62,Noida-201301.
Website : www.hdfcergo.com
HDFC ERGO General Insurance Company Limited YES
POLICY SCHEDULE
Sarv Suraksha - Personal Accident
Family Health Cover
FH
C+
2952202472335301000
Certificate No. :2952 2024 7233 5301 000 Issuance Date :15/10/2019
Mr Hridya Lal Prasad Period of Insurance :From 26/10/2019 00:01 hrs To 25/10/2020 Midnight 0 0
Hno- 82 1St FloorHumayunpur Safdar Jung EnclaveNear N Invoice No. :202472335301000 Premium Frequency :Yearly
C C Gate 01 Mother Dairy Shop .Delhi
Delhi, 110029, Contact No : 7838621737
Proposer Name :Mr Hridya Lal Prasad PAN
Customer Id :100356991909

Insured Details
Insured’s Name Relationship Date of Birth Benefit
Sita . Wife 01/01/1983 50%
Hridya Lal Prasad Self 30/12/1983 100%
Himanshu . Son 04/06/2008 25%
Harshika . Daughter 23/11/2013 25%
Nominee Details
Insured’s Name Nominee Name Relationship
Hridya Lal Prasad Sita Spouse
Coverage Details (UIN : HDFPAIP10004V010910)
Coverage* Sum Insured ( `)
1. Accidental Death
2. Permanent Total Disability 10,00,000
3. Permanent Partial Disability
The Policy Wording includes all the standard coverages offered b y the Company to its customers. Your entitlement for coverage/benefits shall be restricted to the coverage/benefits a s mentioned in this
Policy Schedule issued to you. Please read the Policy Wording in conjunction with the Policy Schedule. For any clarification, please call our toll free number.
Premium Details ( `)
Loadings 0.00
GST 18% : Central Tax 9% ( `101 ) + State Tax 9% ( `101) 202.00
Address 6th Floor, Leela Business Park, Andheri-Kurla Road, Andheri(E), Mumbai 400 059.
For Claim/Policy related queries call us at +91- 22 6234 6234/+91- 120 6234 6234 or Visit Help Section on www.hdfcergo.com for policy copy/tax certificate/make changes/register & track claim.
If the premium i s not realised the policy shall be void from inception. The stamp duty of ;` 1/-paid by Demand Draft, vide Receipt/Challan no
CSD/173/2019/4788 dated 09/10/2019 as prescribed in Government Notification Revenue and Forest Department No. Mudrank 2004/4125/CR 690/M-1, dated
31/12/2004.GST Registration No: 07AABCL5045N1ZA. GST for this invoice is not payable under reverse charge basis.
Branch :unit no 502,504,506, 5th fl, mahatta tower 54, b-1 block, community centr west delhi Write to us :[email protected]
Agent Name :HDFC BANK LTD For HDFC ERGO General Insurance Company Ltd.
Agent Code :201587086428 Tel No. : 91-22-61606161
HDFC ERGO General Insurance Company Limited YES
POLICY SCHEDULE
my: health Medisure Super Top Up
Insurance
Certificate No. :2952 2024 7233 5301 000 Issuance Date :15/10/2019
Period of Insurance :From 26/10/2019 00:01 hrs To 25/10/2020 Midnight
Invoice No. :202472335301000 Premium Frequency :Yearly
Mr Hridya Lal Prasad Proposer Name :Mr Hridya Lal Prasad PAN
Hno- 82 1St FloorHumayunpur Safdar Jung EnclaveNear N
C C Gate 01 Mother Dairy Shop .Delhi Customer Id :100356991909
Delhi, 110029, Contact No : 7838621737

Insured Person’s Details & Sum Insured (UIN : LTGHLIP15001V021415)
Insured's Name Relation with policy Gender Date of 1st Policy Sum Insured Deductible Pre Existing
holder Birth Inception (`) (`) Disease
Hridya Lal Prasad Self Male 30/12/1983 26/10/2019 NO
Sita . Wife Female 01/01/1983 26/10/2019 NO
700000 300000
Harshika . Daughter Female 23/11/2013 26/10/2019 NO
Himanshu . Son Male 04/06/2008 26/10/2019 NO
Nominee Name Sita Relationship Spouse
Premium Details (`)
Loadings 0.00
GST 18% : Central Tax 9% ( `307 ) + State Tax 9% ( `307) 614.00
If the premium i s not realised the policy shall be void from inception.Consolidated stamp duty for this Insurance Policy is paid by Demand Draft, vide Receipt/Challan
no CSD/173/2019/4788 dated 09/10/2019 as prescribed in Government Notification Revenue and Forest Department No. Mudrank 2004/4125/CR 690/M-1, dated
31/12/2004. GST Registration No: 07AABCL5045N1ZA. GST for this invoice is not payable under reverse charge basis.
Branch :unit no 502,504,506, 5th fl, mahatta tower 54, b-1 block, community centr west delhi Write to us :[email protected]
Agent Name :HDFC BANK LTD For HDFC ERGO General Insurance Company Ltd.
Agent Code :201587086428 Tel No. : 91-22-61606161

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HDFC ERGO General Insurance Company Limited

Mr Hridya Lal Prasad

Dear Mr Hridya Lal Prasad

HDFC ERGO General Insurance Company Limited 2952202472335301000

Dear MR HRIDYA LAL PRASAD

Policy Issuing Office: Mumbai

Duly Constituted Attorney

HSN Code :997133 Policy Type :Family Floater

Payment Details : ERGO_CC_15102019 , Date: 15/10/2019, Bank Name:HDFC Bank Ltd

Hridya Lal Prasad Self 30/12/1983 26/10/2018 NO

Duly Constituted Attorney

HDFC ERGO General Insurance Company Limited 4

Payment Details : ERGO_CC_15102019 , Date: 15/10/2019, Bank Name:HDFC Bank Ltd

Agent Code :201587086428 Tel No. : 91-22-61606161

Duly Constituted Attorney

Payment Details : ERGO_CC_15102019 , Date: 15/10/2019, Bank Name:HDFC Bank Ltd

Agent Code :201587086428 Tel No. : 91-22-61606161

Duly Constituted Attorney

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