Date:- 04-August-2019

To,

Bharti Axa General Insurance Co. Ltd

Dear Sir / Madam,

CHANDAN KUMAR SINGH

I am Mr. / Mrs. /Miss. ________________________________________holding the Overseas Mediclaim

BHARTI AXA
Policy of _______________________________vide SX2458065
Insurance Certificate no_______________________

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___________________which is issued for______ Days.

I would like to inform you that I have extended my stay beyond the existing policy period, due
BUISNESS TRIP EXTENSION
to…………………………………………………………………………………………………………………… I would request you to
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extend my above given Insurance for further …….days. I assure you that I am in good
health & there is claim / no claim in existing policy period. I am fully aware and agree that any medical
assistance / disease /injury /ailment and symptoms contracted by me in the old policy or expired period
would be excluded from extended policy.

Details of Claims if any: - 1. Diagnosis:

NOT APPLICABLE
________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

This information provided by me is true and to the best of my knowledge.

Thanks & Regards.