Date : 28 Mar 2023

Mr Raj Kumar Sharma

Mig-a-429 Avas Vikas Kichha
Near Chakradhari Temple
Baheri 263148
Uttarakhand 05

Policy No: 63696273

Mobile No: XXXXXX2541

Dear Mr Raj Kumar Sharma,

Thank You for trusting us as your preferred Health Insurer.

At Care Health insurance, it is our endeavor to make quality healthcare easily accessible for our customers as well as ensure a truly
hassle-free claim servicing experience

To help you understand our services better, please go through the 'Know your policy better' kit that accompanies this letter and
constitutes the following

l Policy certificate
l Premium Acknowledgement

l Key Policy Information

l Claim Process
l Policy Terms and Conditions- https://bit.ly/3UMzQ3S and also available on Customer App

Also appended herewith for your convenience is your Care Health Card. This card should be presented at the time of an emergency
or a planned hospitalization, to avail cashless treatment at our network of over 16000+ cashless network pan-India.

To further simplify procedures, we're online as well. Visit our portal www.careinsurance.com and view network hospitals across the
country, cashless procedures and do much more.

For any assistance, please feel free to write to us at https://www.careinsurance.com/contact-us.html.

Once again, we thank you for this opportunity to serve you, and wish you and your loved ones good health always!

Team Care Health Insurance

CUSTOMER APP

For Android For iOS

 Policy Certificate Policy No. 63696273
Mr Raj Kumar Sharma Plan Name Care Supreme
Mig-a-429 Avas Vikas Kichha Cover type Floater
Near Chakradhari Temple Policy Period - Start Date 00:00 hrs 29-Mar-2023
Baheri 263148 Policy Period - End Date Midnight 28-Mar-2024
Uttarakhand 05
Nominee Name (Relation) VIDHI SHARMA (DAUGHTER)
Premium Paid Rs.27,262.00
Premium Rs 23103.32+CGST Rs
0.00+IGST Rs 4,158.60+SGST Rs
0.00+UGST Rs 0.00
Premium Payment Mode Single Premium

Policyholder Gender Date Of Birth Client ID

Mr Raj Kumar Sharma Male 02-Jul-1970 19338941

Details of Insured Person

Date of Birth Pre-existing Insured with the
Name Client ID Relationship Sum Insured
(DD-MM-YYYY) diseases (since) Company (since)
Raj Kumar Sharma 19338941 MEMBER 02-Jul-1970 NONE 29-Mar-2023 10,00,000.00
Ruchi Sharma 19338942 SPOUSE 01-Jul-1969 NONE 29-Mar-2023

Contact details for Claims & Policy Servicing

Care Health Insurance Limited, Vipul Tech Square, Tower C, 3rd Floor, Golf Course Road, Sector-43,
Correspondence address Gurugram-122009 (Haryana)

E-mail ID for Claims [email protected]

Website www.careinsurance.com

Intermediary Details

Name Code Contact Details

POLICYBAZAAR INSURANCE
20374491 1800-2585970
BROKERS PVT LTD
Schedule of Benefits
S No. Particulars Basis of Offering
1 Sum Insured 1000000
2 In-Patient Care Up to SI
3 Day Care Treatment All Day Care Procedures
4 Advance Technology Methods Up to SI
Up to SI, Pre-Hospitalization expense cover for 60 days
5 Pre-Hospitalization Medical Expenses
prior to hospitalization
Up to SI, Post-Hospitalization expense cover for 180 days
6 Post Hospitalization Medical Expenses
after discharge
7 AYUSH Treatment Up to SI
8 Domiciliary Hospitalization Up to SI
9 Organ Donor Cover Up to SI
10 Ambulance Cover Up to Rs. 10,000
11 Cumulative Bonus 50% of SI, max up to 100% of SI.
12 Unlimited Automatic Recharge Available for unlimited times for unrelated or same illness.
13 Unlimited E-Consultations Available for Consultations with General Physicians
14 Health Services (Health Portal) Doctor on chat, Healthy tips reminder, etc.
Discounts on services such as consultations, diagnostics etc
15 Health Services (Discount Connect)
at our network
16 Room Rent All categories covered.
17 ICU No Limit
18 Named Ailments Coverage 24 Months
19 Pre-existing Diseases Coverage 48 Months
20 Initial Wait Period 30 Days

Optional Cover
S NO. Particulars Details
Upto 100% increase in the Sum Insured, on a cumulative
1 Cumulative Bonus Super basis for each completed and continuous policy year upto a
max of 500%
Discount on renewal premium based on active days
2 Wellness Benefit achieved. Online fitness Coaching/Counselling session
from Wellness Coaches
3 Air Ambulance Cover Up to 5 lacs per year.
For Care Health Insurance Limited

Authorized Signatory
Date of Issue : 28 Mar 2023
Place of Issue : Gurgaon, Haryana
Service Branch : Vipul Tech Square TowerC3rd Floor Sector43Golf Course Road Branch Contact No. : Nil
Gurgaon Haryana 122009Gurgaon,Haryana,122009

Consolidated Stamp Duty paid vide E-Challan GRN no. 98389442 dated 17 Jan 2023, RCM Applicability- N/A
SAC: 997133 and Description of Service: Accident and Health Insurance Services State
GSTIN No.: 06AADCR6281N1ZW
UIN :CHIHLIP23128V012223

Note:
- Attached with this Policy Certificate are the Policy terms and conditions, Optional Covers (if opted) and Annexures. Please
ensure that these documents have been received, read and understood. If any of these documents have not been received,
please feel free to write to us at https://www.careinsurance.com/contact-us.html
- For waiting periods and exclusions under this Policy, please refer to Clause 4 of the Policy terms and conditions.
- This Policy Certificate in original must be surrendered to the Company in case of cancellation of the Policy.
Premium Acknowledgement
Policy No. 63696273
Client ID 19338941
Policyholder Mr Raj Kumar Sharma
Address Mig-a-429 Avas Vikas Kichha
Near Chakradhari Temple
Baheri 263148
Uttarakhand 05

Policy Period 29-Mar-2023 to 28-Mar-2024

Premium Details
Particulars Amount (in Rs.) S.no. Receipt Number Amount Mode of Payment
1 A1608809 27,262.00 IPG
Gross Premium
Care Supreme 19,679.02

NCB Super (Supreme) 2,951.86

Wellness Benefit (Supreme) 61.62
Air Ambulance Cover (Supreme) 410.82

Goods & Services Tax (GST) 4,158.60

Total 27,262.00

The Premium is rounded off to the nearest rupee.

Eligibility of Premium for Deduction u/s 80D of the Income Tax Act, 1961

The premium paid through any mode other than cash for this policy is eligible for Income tax benefits to the person making
the payment subject to the provisions of section 80D of the Income Tax Act, 1961 and amendments thereof. Effective from
Assessment year 2019-20, in cases where health insurance premium for multiple years is paid in one year, it will be eligible
for proportionate deduction in the years in which the health insurance continues to be effective.

For Care Health Insurance Limited

Signature Not Verified
Digitally signed by MANISH DODEJA
Date: 20230328210624
Reason: I'm the author
Authorized Signatory
Location: India
Date of Issue : 28 Mar 2023
Place of Issue : Gurgaon, Haryana

Note:
1) In case of any discrepancy, the Policyholder is requested to contact the Company immediately.
2) Any amount paid in cash towards the premium would not qualify for tax benefits as mentioned above.
3) This document must be surrendered to the Company in case of Cancellation of the Policy or for the issuance of a fresh certificate in
the case of any alteration in the Policy.
4) This Policy is issued subject to realization of the premium amount. In case the instrument given towards the premium amount is
dishonored, then the cover provided under this Policy shall automatically get cancelled. In the given scenario, if any amount has been
paid by the Company in respect of a claim or due to any other reason than the amount so advanced by the Company shall be
refunded to the Company forthwith.
5) We may credit upto Rs. 1/- to your account for validation, before remitting any further payment.
 Proposal Form-'CARE SUPREME'
Dear Mr Raj Kumar Sharma

In reference to your online proposal (1120051254468) for 'Care Supreme'- Comprehensive Health Insurance policy, please find
below the details as provided by you:

Proposer Details
Name : Mr Raj Kumar Sharma
Address : Mig-a-429 Avas Vikas Kichha

Baheri Near Chakradhari Temple,Uttarakhand

263148
Date of Birth : 02-Jul-1970

Landline :

Mobile : XXXXXX2541
E-mail : [email protected]

Details of the Persons be Insured

Name Date of Birth Relation Pre-existing Diseases

Raj Kumar Sharma 02-Jul-1970 MEMBER NONE
Ruchi Sharma 01-Jul-1969 SPOUSE NONE

Additional Details

1. Does any person(s) to be insured has any pre-existing diseases?

Insured1 Insured2
N N
2. Have any of the person(s) to be insured ever filed a claim with their current / previous insurer?
Insured1 Insured2
N N
Has any of your proposal(s) for Health insurance been declined, cancelled, charged a higher premium or
3.
issued with special condition(s)?
Insured1 Insured2
N N
Is any of the person(s) proposed for insurance covered under any other health insurance policy with the
4.
Company or any other Company without break?
Insured1 Insured2
N N
 You agreed to following terms & conditions of the purchase of policy

a. I have read and understood the Brochure/Prospectus/Sales Literature/Terms and Conditions of the Policy and confirm to abide by
the same.
b. Receipt of proposal form by the Company shall not be construed as acceptance of proposal. Commencement of risk under the Policy
shall be subject to realization of full premium and individual underwriting by the Company. The Company at its sole discretion reserves
the right to accept or reject or load any proposal. Policy would start from the date as specified in the Policy Certificate.

c. I understand that the Policy Period Start Date as specified in the Policy Certificate shall be from the 00:00 hours of the next day of the
Proposal receipt at branch/online, proposed policy period start date as opted by me or cheque date, whichever is later.

d. I understand that the Policy shall become void at the Company's option, in the event of any untrue or incorrect statement,
misrepresentation, non-description or non-disclosure of any material fact, in the proposal form/personal statement, declaration and
connected documents or any material information having been withheld by me or anyone acting on my behalf.

e. I hereby declare that the lives proposed to be insured would submit to medical examinations before the nominated doctors of the
Company or undergo diagnostic or other medical tests, as suggested by the Company for its underwriting.

f. I consent to and authorize the Company and/or any of its authorized representative agents to seek medical information from any
hospital/medical practitioner or any other related entity that I have attended or may attend in future concerning any illness or injury.
g. I consent to provide a valid age proof and identity proof at the time of claims or any other time when required by the Company.

h. I authorize the Company to exchange, share or part with the information relating to myself/person(s) to be insured with any external
entity other than regulatory and statutory bodies, as may be required and I will not hold the Company or its agents liable for use/sharing
of this information.

i. I/We agree and undertake to convey to the Company any change/alterations carried out in the risk proposed for insurance after
submission of this proposal form.

j. I/We consent to receive information from the Company the through physical, electronic or telecommunication means from time to time.

The undersigned hereby declare on my behalf and on behalf of each of the persons proposed to be insured that the above statements and
particulars are true, complete and correct in all respects and that all information which is relevant to this proposal has been disclosed and
not withheld from the Company. I declare that the money used to make the premium payment has not been derived from any illegal
activity or unaccounted funds. I further declare and agree that this declaration and the answers given above shall be held to be promissory
and shall be the basis of the contract between me/us and the Company.

By virtue of this communication, I give my implicit approval on receiving Whatsapp, SMS, E-mail (Transactional & promotional) from the
company

The details mentioned in above proposal form have been verified through OTP received on my registered mobile number.

The details mentioned in above proposal form has been verified through OTP Y
No physical Health Cards will be dispatched. The electronic version of the card below will be accepted across all network providers.

63696273

19338941 02-Jul-1970 Raj Kumar Sharma

19338942 01-Jul-1969 Ruchi Sharma