Date: 2020-10-12

Previous Policy Number 1000248121-08

Product Upgrade

Existing Product Name New Product Name

Easy Health Standard

Optima Restore Individual
Individual

Health Status Declaration

I hereby confirm that after commencement of my policy with HDFC ERGO Health, none of the members under the
policy have met with any accident/injury or been diagnosed with any disease/illness except common cold, diarrhea,
fever, childbirth.

We have received your request. It will be processed shortly.

Thanks and Regards,

Team HDFC ERGO Health.

This is Auto-Generated Mail while upgrading your Health Policy Online through HDFC ERGO Health website.

We would be happy to assist you. For any help contact us at: E-mail: customerservice@hdfcergohealth.com Toll Free: 1800-102-0333

HDFC ERGO Health Insurance Ltd. • 2nd & 3rd Floor, iLABS Centre, Plot No. 404-405, Udyog Vihar, Phase-III, Gurgaon - 122 016, Haryana • Corp. Off: 1st Floor, SCF -19, Sector - 14, Gurgaon
- 122 001, Haryana. • Regd. Off: 101, First Floor, Inizio, Cardinal Gracious Road, Chakala, Opposite P & G Plaza, Andheri (East), Mumbai, Mumbai City, MH 400069 IN. • Insurance is the subject
matter of solicitaition. • For more details on risk factors, terms and conditions please read sales brochure carefully before concluding a sale. Tax laws are subject to change. • IRDAI Reg. No.: - 131
• CIN: U66030MH2006PLC331263