ANNEX-VI Ref-No : PAT-L-019-2021-0074 Date : 10-JUL-2020 Mr. MANENDRA KR SINGH S/O MITHILESH KR SINGH C/O M/S O BIQUETTE AND FUEL SUBHADRA ENCLAV c3, ASHOK KUNJ PO-ASHOK NAGAR PS-ARGORA, Ranchi, Jharkhand-834002 Mobile No. : Dear Sir/Madam, Re: Complaint No. : PAT-L-019-2021-0074 COMPLAINANT : Mr. MANENDRA KR SINGH vis RESPONDENT : HDEC Standard Life Insurance Co, Ltd. (Mumbai) ‘You are hereby informed that your complaint dated 10-JUL-2020 has been registered arising out of policy No. 17054678,17149050 issued by the respondent. ‘ ‘You shall send your written consent in terms of Rule 13(2) of The Insurance Ombudsman Rules, 2017 for Ombudsman to act as a mediator between yourself and Company and give his recommendation for the resolution of the complaint. ‘You shall also send details of the complaint (as per enclosed Annexure VI A) with copies of all the documents in support of your claim /grievance against the decision of the insurance Company along with copies of representation made by you to the Insurance Company against the final decision of the Company and the decision against your grievance, if any received from the Insurance Company. Please send a photocopy of the full policy document duly signed by you. Allthe above documents should reach this office within 10 days from the receipt of this NOTICE If we do not receive above referred requirements within the stipulated time, we shall close the complaint without further correspondence in the matter. Yours faithfully, Asstt./Dy/Secretary ENCL: As above Scanned with CamScanner| ANNEGVLA To, ‘The Insurance Ombudsman, Kalpana Arcade Bldg, st Floor, ‘Bazar Samiti Road, Bahadurpur, Patna-800006. Re: Complaint Branch/Divison : Mumbai Policy No: 17054578,17149050 ‘Me, MANENORA KRSINGH Complaint No. :PATL-019-2021-0074 jainst: HOFC Standard Life Insurance Co. Ld, (Mumbal) Being aggrieved,! am lodging complaint against the above referred Insurance Company. Details are given as under:- 1L.Complainants full Name and Address Name: Address: ‘Telephone No. Landline No. Mobile No. Emall.: Relationship tothe insured Person: _2Name of the Insurance Co. Office address Division / Branch 23.Policy Number: 4, Subject Matter of complaint and bref facts ofthe case : 5. Date of preferring your laim/ complaint to the office (please enclose copy ofthe letter): 6. Date of reply of Insurance company: (clease enclose acopy ofthe letter: 7.ate any proceedings before any Court/ Consumer Forum/ Atbitratoron the same subject matterpending or were so earlier £8. Nature and extent of monetary Loss, if any, (Incase of General insurance cases only) 9. Quantum of relief sought: (Mr. MANENDRA KRSINGH S/O MITHILESH KR SINGH C/O M/S. BIQUETTE AND FUEL SUBHADRA ENCLAV c3, [ASHOK KUNI PO-ASHOK NAGAR PS-ARGORA, Ranchi, sharkhand-834002 . j- 7466517 7. _irsayoooes,, 44300273 - eMboy aorequaid. com HFC standard Life Insurance Co.Ltd. (Mumbai) 13TH FLOOR, LODHA EXCELUS APOLLO MILLS COMPOUND INMJOSHIMARG, MUMBAL-12 ‘Mumbai 137054678,17149050 (eth ant Fok eooket REFuND OF EnrikE THE POLICY 23)os pore ANNEX D 24/04 for) ANNEX TE S/o [2019 ANNEX IZ.” ere PRINCIPAL — 25, 00,000 INTEREST -_6,00,000 =ToTAL 31,00, v00/— (THR ONE LACS ONLY) Scanned with CamScanner10.(a)Particulars of representation made against repudiation Of daim to 00/ RO/ 20/Grievance Cell and outcome thereet: (b) I not made reprezentation give reasons, Ifany: 11. hereby declare and solemnly affiem that 2} The information given above is tue to the best of my knowledge end belief. b) The complaint was lodged with the Insurance Company onas percopy enclosed and the company has rejected my sim ‘complaint/ not replied even after amonth/ replied on but the sameis not acceptable tome. The period af one year has notelansed from the date of rejection letter or final from the Insurance Company. 4) The complaint is not on the same subject matter for which any proceedings before any court or consumer forum or arbitrator are pending/ settled or were soearier €¢) The subject matteris not decided earlier by your office or any office ofthe insurance Ombudsman. 12,1/ We enclose copies ofthe following documents: 4. Copy of complaint letter written tothe Insurance Company. 2. Copy of reply received from the sad Insurance Company. 3. Copy of reminder, if any. rectal cad : : (signature ofthe c To, The Insurance Ombudsman, Kalpana Arcade Bldg, 1st Floor, Bazar Samiti Road, Bahadurpur, Patna-800006. ear Sir, Insurance Co. td. (Mumbai) ‘Re: Complaint against: HOFC Standard Branch / Division Mumba Policy No : 17054678,17349050 [Name : Me. MANENDRA KR SINGH s Your Reference :PAT-L-019-2021-0074 with reference to your letter dated [letter_date_of_annex_6] onthe above subject. / We here by give my/our unconditional and irrevocable Consent for the Insurance Ombudsman to act as a mediator between the Insurance Company and myself and give his recommendations for the resolution of complaint. {E"thereby give my consent for Audio and/or Video Hearing, ifthe prevailing conditions are not condudve for hearingin the Office of Insurance Ombudsman”. (I yes, please tick“) Kindy give your recommendation atthe earliest. Yours fachfully/{_ (sighed Scanned with CamScanner