HDFC ERGO General Insurance Company Limited

Date : 18/06/2019

2952201431145002009
MR. PRAJWAL SUNDAR SHETY
E1-8, A-7, TRIMURT APARTMENT, SECTOR-8, NERUL WEST.
NAVI MUMBAI, 400706
MAHARASHTRA
Contact No : 9702102142

Dear Mr. Prajwal Sunda Shetty

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 2952201431145002009 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 2952201431145002000

Dear MR. PRAJWAL SUNDAR SHETTY

Subject : Certificate for the purpose of deduction under section 80 D of Income Tax (Amendment) Act, 1986

This is to certify that we have received an amount of ` 31755 (RUPEES THIRTY ONE THOUSAND SEVEN HUNDRED FIFTY-FIVE AND ZERO PAISE Only) towards
premium for Health Suraksha Policy , Policy No. 2952201431145002009 issued to for the period 28/06/2019 to 27/06/2020.

Note:

1. This is subject to the provisions of Section 80D of income tax (Amendment) Act, 1986 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 policy holder.
Date : 18/06/2019 For HDFC ERGO General Insurance Company Ltd.

Policy Issuing Office: Mumbai

Duly Constituted Attorney

Renewal Coupon - Yearly Free Health Check Up

Being our valued customer, you are now eligible for a yearly free Health Check Up worth Rs. 1000

Call 1800 2 700 700 to fix an appointment

Visit the selected diagnostic center at the scheduled time

The eligible Insured Person(s), is/are entitled for one time health check up benefit up to an amount of Rs.1000, which will be valid for 180 days from policy
renewal date.
Please carry the photo copy of your policy to the hospital/nursing home.

HDFC ERGO General Insurance Company Limited. (Formerly HDFC General Insurance Limited from Sept 14, 2016 and L&T General Insurance Company Limited upto Sept 13, 2016).CIN: U66030MH2007PLC177117.
Registered & Corporate Office: 1st Floor,HDFC House, 165 - 166 Backbay Reclamation,H. T. Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service Address: D-301, 3rd Floor, Eastern Business District
(Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078. Toll Free Number: 1800 2700 700 Te.: +91 22 6638 3600 | Fax: 91 22 6638 3699 | care@hdfcergo.com | www.hdfcergo.com.
IRDAI Reg No.146
HDFC ERGO General Insurance Company Limited
POLICY SCHEDULE
Master Policy No.5026567750265694

Certificate No. 2952 2014 3114 5003 000

Health Suraksha Policy
0
Customer Id : 102026504611

Proposer Name MR. PRAJWAL SUNDAR SHETTY PAN No. Premium Frequency Yearly
Corr. Address/ E1-8, A-7, TRIMURTI APARTMENT, SECTOR-8, NERUL Permanent E1-8, A-7, TRIMURTI APARTMENT, SECTOR-8, NERUL
Place of Supply WEST, NAVI MUMBAI - 400706 Address WEST, NAVI MUMBAI - 400706
Mobile 9702102142 Phone E Mail PRAJWALSHETTY456@GMAIL.COM Policy Type Individual
Period of Insurance From Date & Time 28/06/2019 00:01 hrs To Date & Time 27/06/2020 Midnight Policy Issuance Date 18/06/2019
Insured Person’s Details & Sum Insured
Insured's Name Relationship Date of Birth Member ID 1st Policy Portability Pre Existing
Inception Sum Insured (`) Disease

PRAJWAL SUNDAR SHETTY Self 10/12/1993 28/06/2018 NO

Sum Insured (`) 15,00,000.00 CB Amount (`) 300,000.00

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 PRADEEP SUNDAR SHETTY Relationship Sibling

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. 6000 Covered
hospitalisation)
Health Check up per family (Post 4 Claims free Upto 1% Sum Insured,Maximum Upto Rs Enhanced Cumulative Bonus 10% of Sum Insured; Maximum
years) 5000/- 100%
Regain Benefit 100% of basic Sum Insured

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 26,911.00
Loadings 0.00
GST 18% : Central Tax 9% ( `2422.0 ) + State Tax 9% ( `2422.0) 4,844.00
Total Premium 31,755.00

Payment Details
Cheque No./DD/Fund Transfer Date Bank Name
ERGO_CC_18062019 18/06/2019 HDFC Bank Ltd

Invoice No. 2014311450020003 HSN Code 9971

For Claim Services Phone 1800 2700 700 Fax no. 1860 2000 600 E-mail healthclaims@hdfcergo.com
Address HDFC ERGO General Insurance Company Ltd. 5th floor, Tower 1, Steller IT Park, C-25, Sector-62,Noida-201301.
For any other query call toll-free 1800 2 700 700 or email us at care@hdfcergo.com or log on to www.hdfcergo.com
If the premium is not realised the policy shall be void from inception.
2004/4125/CR 690/M-1. , Goods & Services Tax Registration No: 27AABCL5045N1Z8. Goods and Services Tax for this invoice is not payable under reverse charge basis.
Branch :LEELA BUSINESS PARK, 6TH FLR, ANDHERI - KURLA RD, MUMBAI, 400059. Phone No. : +91-22-66383600
Write to us : feedbackgeneral.insurance@in.hdfcbank.com

For HDFC ERGO General Insurance Company Ltd.

Agent Name :HDFC BANK LTD

Agent Code :201587089428 Tel No. : 91-22-61606161 Duly Constituted Attorney

HDFC ERGO General Insurance Company Limited. (Formerly HDFC General Insurance Limited from Sept 14, 2016 and L&T General Insurance Company Limited upto Sept 13, 2016).CIN: U66030MH2007PLC177117.
Registered & Corporate Office: 1st Floor,HDFC House, 165 - 166 Backbay Reclamation,H. T. Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service Address: D-301, 3rd Floor, Eastern Business District
(Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078. Toll Free Number: 1800 2700 700 Te.: +91 22 6638 3600 | Fax: 91 22 6638 3699 | care@hdfcergo.com | www.hdfcergo.com.
IRDAI Reg No.146
HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited 1

Policy No.:2952201431145002000 This card is for identification purpose only.
Valid From: 28/06/2018 Renewal Date: 27 June
Card has to be presented to the Network Service Provider at the time of admission/ availing
cashless hospitalization o r any other services. Insurance claim will be processed in accordance
Insured Name Date Of Birth Gender with the policy term & conditions. Card does not guarantee cashless hospitalization or any other
service. For more details and updated list of Network Service Provider please refer our website or
DEEPAK VISHNU BHATT 10/07/1967 Male call our call centre. This card is valid till the time policy is active.

Phone Number : 1800 2 700 700

Fax Number : 1860 2000 600
Email : healthclaims@hdfcergo.com
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. (Formerly HDFC General Insurance Limited from Sept 14, 2016 and L&T General Insurance Company Limited upto Sept 13, 2016).CIN: U66030MH2007PLC177117.
Registered & Corporate Office: 1st Floor,HDFC House, 165 - 166 Backbay Reclamation,H. T. Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service Address: D-301, 3rd Floor, Eastern Business District
(Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078. Toll Free Number: 1800 2700 700 Te.: +91 22 6638 3600 | Fax: 91 22 6638 3699 | care@hdfcergo.com | www.hdfcergo.com.
IRDAI Reg No.146