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Activ Health - Endorsement Schedule - Non Financial

Policy Issuing Office : Policy Servicing Office :


G B Rain Tree Place,
10th Floor,R-Tech Park,Nirlon Compound,Next To HUB Mall,Off No-7, MC Nichols Road,
Western Express Highway,Goregaon East,Mumbai-400063 Chetpet,
,CHENNAI,TAMIL NADU,600031

Endorsement Number : 11-19-0012602-00-01 Date of Issue : 14/09/2019

Endorsement Effective Date & Time : 14/09/2019

Endorsement Request date : 14/09/2019

Policy No. : 11-19-0012602-00

Name of Policyholder : Mr Jagannathan N

Address : No 25, Old No 7, Rajamangalam 7th St Villivakkam .


Landmark : City : Ambattur
State : TAMIL NADU PIN Code : 600049

Period of Insurance : From : 02/08/2019 To : 01/08/2022

Notwithstanding anything to the contrary contained in the policy, it is hereby declared and agreed that the Contact details in the policy
stands updated as below

New Contact Details 9841876906

In consequence thereof, premium under the policy remains unaltered.

Subject otherwise to the terms, conditions, exclusions, limitations and warranties attached to the within mentioned policy.

For and on behalf of Aditya Birla Health Insurance Co. Limited

Authorized Signatory

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