Mr Abhishek Saxena 25-Jun-2014

50 Friends Vihar Dayalbagh Agency Code 80095655

Agra - 282005 Agency Name BHAWNA GOEL
Uttar Pradesh
Agency Contact No 9313153084
India
Contact No.: 9971279997
Policy No: 110101/11119/6000112372-01

Renewal of Your Optima Restore Insurance Policy

Dear Mr Abhishek Saxena,

Thank You for renewing the policy with us.

We are pleased to enclose your renewed Policy Kit for the period 23-Jul-2014 to 22-Jul-2015. The Kit contains:

1. The Policy Schedule along with income tax (80 D) certificate (wherever applicable)
2. Member cashless card/s
3. Important Information related to Claim Procedure, and
4. Let's Stay Healthy - Value adds from Apollo Munich

To know more about policy related information and value added offers, you may re-register yourself at our website using
your unique member ID and policy number as mentioned in the policy schedule.

In case of any query, please feel free to write to customerservice@apollomunichinsurance.com or call us at our 24 hours
toll free number 1800-102-0333. Our customer care team will be happy to assist you.

Warm Regards,

Authorized Signatory

Note:-
- Revision in Policy wordings (if any) due to regulatory compliance or any other reason can be accessed through our
website www.apollomunichinsurance.com.
- Please update us with your latest contact details (in case of any change) so that same can be updated in our records.
You can either write back to us or call us on our toll free no. 18001020333.
 OPTIMA RESTORE POLICY SCHEDULE - Optima Restore Individual

Issuing Office: Pitampura Sales Office

Policy Holder's Name: Mr Abhishek Saxena
Policy Holder's Address: 50 Friends Vihar Dayalbagh
Agra - 282005
Uttar Pradesh
India
Agency Code: 80095655
Agency Name: BHAWNA GOEL
Agency Contact No: 9313153084
Policy Number: 110101/11119/6000112372-01
First policy inception date: 23-Jul-2013
Policy Period: From 00.00 hrs on 23-Jul-2014 To 24.00 hrs on 22-Jul-2015
Insured Persons Details:
Member ID Insured Person's Name Age Relationship to Policyholder Basic Sum Insured (Rs.) Multiplier Benefit (Rs)
10005815857 Mr Abhishek Saxena 24 Policy Holder 500000 250000

Nominee Name: Mrs Anju Saxena Relationship: Mother

The nominee must be an immediate relative of the policyholder. For all other Insured Persons the policy holder shall be the nominee.
Premium Calculation:
Net Premium (Rs) 5609.00
Discounts (Rs) 0.00
Loadings (Rs) 0.00
Service Tax (Rs) 673.08
Duties and cess as applicable (Rs) 20.19
Gross Premium (Rs) 6302.27
Gross premium amount (in words) Rupees Six Thousand Three Hundred Two and Paisa Twenty-
Seven Only

The stamp duty of Rs. 0.50/- (Paisa Fifty Only) paid vide No.F.10(783)/COS(HQ)/Con.duty/08. (Not applicable for the state of
Jammu & Kashmir).
Service Tax Registration No.: AAGCA1654HST002
EXCLUSION(S) / SPECIAL CONDITION(S):
Member ID No of Insured Person Name Details
10005815857 Mr Abhishek Saxena For Rs 500000 (Rupees Five Lakh) Sum Insured - Sec 4B) of the
policy wording is waived, Sec 4C) is reduced to 1 year and Sec
4D) is reduced to 2 years.

Claim Administrator: Apollo Munich For and on behalf of Apollo Munich Health Insurance Company Limited

Location: Gurgaon
Date: 25-Jun-2014 Authorized Signatory
 Certificate for the purpose of deduction under Section 80 D of Income Tax (Amendment) Act, 1986*

This is to certify that MR Abhishek Saxena has paid Rs 6302.27 (Rupees Six Thousand Three Hundred Two and Paisa Twenty-Seven
Only ) towards premium for Optima Restore Individual Policy No 110101/11119/6000112372-01 issued to Mr Abhishek Saxena
for period 23-Jul-2014 to 22-Jul-2015.

For and on behalf of Apollo Munich Health Insurance Company Limited

Location: Gurgaon
Date: 25-Jun-2014 Authorized Signatory

* 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.
3. Please note that this certificate will not be issued if the premium payment has been made in cash.