PREMIUM COMPUTATION SHEET

Department : MISCELLANEOUS Insured's Name : A Sukumar

Document No : R/431300/48/2020/1687 Document Date : 04/09/2020

Policy Start Date : 26/09/2020 Policy End Date : 25/09/2021

Product Description : MEDICLAIM INSURANCE Document Type : Proposal

POLICY(INDIVIDUAL)
Policy Type : Mediclaim Insurance Policy(Individual)

SCHEDULE OF PREMIUM
Cover Description Sum Insured Premium

Basic Cover-Mediclaim 3,00,000.00 13,799.00

LESS :Family Package Discount 0.00 1,380.00
TOTAL PREMIUM 12,419.00
ADD :CGST 1,118.00
ADD :SGST 1,118.00
STAMP DUTY 0.50
TOTAL AMOUNT 14,655.00

RISK DETAILS

Section : Mediclaim Insurance Policy(Individual)

Individual Details : A Sukumar

Cover Name Sum Insured Rate Premium

Basic Cover-Mediclaim 1,00,000.00 6063/1 6,063.00

Total 6,063.00

Section : Mediclaim Insurance Policy(Individual)

Individual Details : Mrs. S Rajyalakshmi

Cover Name Sum Insured Rate Premium

Basic Cover-Mediclaim 1,00,000.00 6063/1 6,063.00

Total 6,063.00

Section : Mediclaim Insurance Policy(Individual)

Individual Details : S Ashwin Kumar

Cover Name Sum Insured Rate Premium

Basic Cover-Mediclaim 1,00,000.00 1673/1 1,673.00

Total 1,673.00