rir MediPrime Renewal Notice AIG NODA 201301 Deve of N generator: 18 Sep 16 Urtas PRADESH Renewal Reerence No: ANDZOO2O21 Dear GOVINO NAGAR, We thank you or chocting Tata AXG Genera Insurance Company Limited as your preferred general insurer for heath product Your Heath Insurance Pelcy i (on 15-OCT-16. You are requested to renew your policy prior to expiry date zo a to continue to enjoy the continuity benefit ‘As perthe Existing MediPrime PoSzy, Your Renewal Premivm® due s is, 11129 /-< Total Premium inclusive of service tox @ 18% > Your Existing Policy dete are az Follows — Pian Type :2Aduts + 3011 Year) Wenberid | Wrawred Persans Name | Age] Relatonahip | Sum] Cumulative ] Gaim ] Gaim | Net] Rak | Discoumt | Tal Inswed |Bonus stad) Stan | Amoure | Premium | toadag | Amount™*| Premun oy Amour wa | me) | me | me [ MERCZERTESEOTO | — GOVINO NAGE ar 7 7 IT v ED 28 | MaercaESTeSeORD | — DINED NAGA Wie 7 v 26 TWENGEESTESSESD| —SAXSHINSGAR [3] —Daaghaer 7 7 a od t v 8 a a ter 7 T o ‘Premium rate icicle of appcabl service tax 58 Cess 6 KK Cees @ 18% ++ Family acount of 1%, 43 or mere members ofa erly wre covered under the same patcy en Invidua rn ncured baie andor 8% Dizzout on premium #Insu Person is paying premium of2 years nwdvence. | Aa per the leading Seppe for previous MediPime Paty £8 Cumutve Bonus a: mentioned in Policy Worsings. ‘Cumulative bonus (C8) given is es on 60 Gays prior to your policy expiry. Any claim registered ate this dete, C8 willbe adjusted eccoréngly Pleate pay your premium by cach and cheque/DOPay Order drawn in favor of Tate ANG General insurance Company Limited’.