HDFC ERGO General Insurance Company Limited

2806203651864301000

Mr S Subrahmanyam
405 S.M.R.Vinay Classic Koundapur
Lane Next To Navayuga Info Tech
Hyderabad Telangana - 500032
Contact No.: 9618050940
Email: [email protected]

Policy No : 2806 2036 5186 4301 000

Intermediary Code Intermediary Name Intermediary Contact Number

200663627169 RAJANI K 91-7093361435

Renewal of Your Easy Health Individual Exclusive Two Year Insurance

Dear Mr S Subrahmanyam ,

Welcome to HDFC ERGO General Insurance Company Limited. We are pleased to issue you Renewal of Your Easy Health Individual Exclusive Two Year
Insurance Policy. We advise you to retain your Policy Kit during the entire term of the Policy (including renewals).

Please note that the Policy has been issued to you based on the declarations, details and documents received from/on behalf of you in/along with the Proposal
Form submitted to us.

Please visit our website www.hdfcergo.com for more information about our Company, Grievance handling and any other support. To know the updated list of our
network hospitals please visit https://www.hdfcergo.com/locators/cashless-hospitals-network

We value your relationship with us and assure you our best services at all times and we look forward to serve you.

Warm Regards,

Location: Mumbai
Authorized Signatory Date: 10/06/2022

Note:
1. Please update us with your latest contact details (in case of any change) so that same can be updated in our records.
2. You can either email us on [email protected] or call on our Customer care no. 022 6234 6234 / 0120 6234 6234.
3. *The Copy of the proposal form has been sent on your registered email id if policy is purchased through website.

Certificate for the purpose of deduction under Section 80 D of Income Tax Act, 1961*
This is to certify that the S SUBRAHMANYAM has paid Rs. 43275 (Rupees Forty-Three Thousand Two Hundred Seventy-Five And Zero Paise Only) towards
premium for Easy Health Individual Exclusive Two Year Policy No. 2806203651864301000 issued to S SUBRAHMANYAM for period of 15/06/2022 to
14/06/2024.

For and on behalf of HDFC ERGO General Insurance Company Limited

Location: Mumbai
Date: 10/06/2022

Authorized Signatory
*Note

1. This is subject to the provisions of Section 80D of Income Tax Act, 1961 as amended from time to time.
2. 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 Policyholder.
3. Please note that this certificate will not be issued if the premium payment has been made in cash.
4. In case of dishonor of the premium instrument, the policy will be deemed cancelled ab initio.
5. 80D benefit is applicable for only Self, Spouse, Dependent Children and Dependent parents.

HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN: HDHHLIP21378V062021. 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
HDFC ERGO General Insurance Company Limited

Policy Schedule - Easy Health Individual Exclusive Two Year

Policy Number 2806 2036 5186 4301 000

Policy Holder’s Name Mr S Subrahmanyam
Policy Holder’s Address 405 S.M.R.Vinay Classic Koundapur Lane Next To Navayuga Info Tech Hyderabad Telangana - 500032
Policy Holder State Name & Code Telangana (36) Place of Supply TELANGANA
GSTIN/ UIN (if any) of Policy Holder
First policy inception date 06/06/2011 Policy Issuance Date 10/06/2022
Policy Period From 00:01 hrs on 15/06/2022 To 24:00 hrs on 14/06/2024
211, BHUVANA TOWERS, S D ROAD, SECUNDERABAD-500003,TELANGANA HYDERABAD Tel :
Issuing/Servicing Office
+91-22-66383600
GSTIN 36AABCL5045N1Z9
Intermediary Name RAJANI K Intermediary Contact No 91-7093361435
Intermediary Code 200663627169 Description/ Harmonized System Of Accident and Health insurance
Nomenclature Code Services/9971
Insured Person Details
Member 1 Member 2 Member 3 Member 4 Member 5 Member 6
S
Particulars / Member ID
SUBRAHMANYAM /
202009282802440
Date of Birth (Age) 01/08/1968 (53) - - - - -
Relationship to Policy Holder Self - - - - -
Base Sum Insured (`) 750000 - - - - -
Cumulative Bonus (`) 480000 - - - - -
Protector Rider
- - - - - -
Sum Insured (`)
Total Sum Insured (`) 1230000 - - - - -
Other Riders and Benefits ( `)
Protector Rider - - - - - -
Hospital Daily Cash Rider SI
- - - - - -
(Max. 30 days)
Critical Advantage Rider SI
- - - - - -
($)
IPA Rider SI - - - - - -
Critical Illness SI - - - - - -
Nominee Details
Nominee Name : Mrs S V S Padmavathi Relationship to Policyholder: Wife
The nominee must be an immediate relative of the policyholder. For all other Insured Persons the policy holder shall be the nominee.
Premium Calculation (`)
Net Premium 36674 CGST@9% 3300.5
Discounts 0 SGST/UTGST@9% 3300.5
Loadings 0 IGST@18% 0
Taxable Premium 36674 Any other Cess or Taxes 0
Gross Premium 43275
Gross Premium (in words) Rupees Forty-Three Thousand Two Hundred Seventy-Five And Zero Paise Only
The stamp duty of Rs. 1/- ( Rupees One And Zero Paise Only ) paid vide e-stamp Certificate No. LOA NO. CSD/366/2022/2430 dated 06/06/2022.
Original for Recipient/ Duplicate for Supplier
Whether tax is payable on reverse charge basis: No

Exclusion(s) / Special Condition(s) (Refer the leaflet attached in the policy document w.r.t. exclusions) :
Member ID No. Name Exclusion Type Applicable Health Condition Exclusion Portability/ Renewal Benefit
on SI Duration
(Years)
202009282802440 S SUBRAHMANYAM For Rs 300000(Rupees Three Lakhs)
Sec 6 A (i) and Sec 6 A (ii) Sec 6 A
(iii) of the policy wording is waived.

For Rs 100000(Rupees One Lakhs)

Sec 6 A (i) and Sec 6 A (ii) Sec 6 A
(iii) of the policy wording is waived.

For Rs 100000(Rupees One Lakhs)

Sec 6 A (i) and Sec 6 A (ii) Sec 6 A
(iii) of the policy wording is waived.

For Rs 250000(Rupees Two Lakhs

Fifty Thousand) Sec 6 A (i) and Sec 6
A (ii) of the policy wording is waived
and Sec 6 A (iii) is reduced to 1 year.

HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN: HDHHLIP21378V062021. 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
HDFC ERGO General Insurance Company Limited

Policy Schedule - Easy Health Individual Exclusive Two Year

Claim Administrator : HDFC ERGO General Insurance Company Ltd For and on behalf of HDFC ERGO General Insurance Company Limited

Location: Mumbai Authorized Signatory

Date: 10/06/2022

"For detailed policy terms and conditions please visit our website https://www.hdfcergo.com/download/policy-wordings "

HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN: HDHHLIP21378V062021. 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
HDFC ERGO General Insurance Company Limited

Terms and Conditions

(1) This card would be valid till your relationship with HDFC ERGO General Insurance
Policy No.: 2806203651864301000 Company Limited / This card is invalid if the policy is cancelled (2) In case of renewal please
refer original policy number (3) This card is issued for the purpose of identification only and does not
entail automatic cashless facility at the network hospital. (4) A photo ID issued b y any government
authority i s to be produced to avail cashless facility. (5) Please apply for cashless facility 48 hours prior
to admission in case of planned admissions and within 24 hours of admission in case of emergency.(6) All
Insured Name Gender terms and conditions of the policy would be applicable while processing your cashless request. (7) In case
S Subrahmanyam M your cashless facility i s denied due to any reason, please submit the claim for reimbursement. Denial of
cashless facility does not indicate rejection of the claim. (8) Please read policy documents carefully for
detailed terms and conditions. For claim status visit help section on our web site www.hdfcergo.com.
Alternatively you may write to us at [email protected].

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146 CIN: U66030MH2007PLC177117.
Registered & Corporate Office: 1st Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh
Marg, Churchgate, Mumbai – 400 020. Health Claim Services Address : HDFC ERGO General Insurance
Company Limited Stellar IT Park, Tower-1 , 5th Floor, C - 25, Noida, Sector 62, 201301, Uttar Pradesh.
Service No. 022-62346234/ 0120-62346234Email: [email protected] Logo displayed
above belongs to HDFC Ltd and ERGO International AG and used by the Company under license.

HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN: HDHHLIP21378V062021. 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