NATIONAL INSURANCE COMPANY LTD

(A Govt. of India Undertaking)

National Insurance Regd.& Maq0fiop3, Middleton Street, Kolkata-700 071
: 3, MEa E, sa 700 071
Barrackpote krahdh Office: Atindra Complex, 1st Floor,
87/20, Ghosh Pára Road, 24 Parganas (N),
87/20, u TE, 24 qRTUT (3TR) Barrackpore, Pin-700 120
r, a 700 120 Phone:033-2592 0146, 2593 5030
7:033-2592-0146, 2593 5030

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***

National Madiriaia
Polic 154501/48/14/SDDA17?

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ontact Nyahar. 43731 7764

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ustomer Nape: SETR ENNA PAN

Phone
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PIKDR E-Mal
nrt 74 Parnanas. Wet Rannal

Polir Eftert ive frop Ri: h hr. an 20/07/70i4 to Bidnioht of 19/07/2015

.3465 Covar Note Nugbar and datea:

Preeiue
Sarvice Ta: ke.i Brogosal Nuahar and Date: 54501 1An00024 14/07/2014

Raceint Nugher and bate: 154501/81/14/0000005512 14/07/2014

Total Asount: s,455 15450148138500n018n5 19/07/2014

Pravious Palicy Number and Exoirv Date:

ONLV
in ords RUPEES FOUMR THINISAMD FOIR HUNDRED FIFTY FTVE

hetai?s ot Iakurad kersons

Pra-axistinM
Age Relatjon Occunation 6endar I Sun Insureadl C IDjAaEas Tacantin
. Nape of the Insured IDgte of
kirth
Agount Exclusions:Data
Per s

3/12/1478 3 lf Seryice 75hdn NORNAL POLTEY 20/n7/70g

SUP1R GHSH EKCLUSTAN
NORMAL POLICY
FXCWSTON
ENBANCED SIM
INSIUREN

20.07,20141
17/67/19R 15 f HoySA Vita ?5000 NORMAL POLITV 20/01 2009
MOUGLUMT GHH YCISTON
GALL AL ODER
PROBLEN TUY 011195
 TT
NATIONAL INSURANCE COMPANY LTD.
(A Govt. of India Underfaking)
National Insurance Regd.&Head Office:3, Middleton Street, Kolkata-700 071
T t a : 3, RBaea iz, BMam- 700 071 1st Floor,
Barrackpore Branch Office : Atindra Complex,
87/20, Ghosh Para Road, 24 Parganas (N),
87/20, T TEI E, 24 TT (TTR), Barrackpore, Pin - 700 120

r , RA 700120 Phone:033-2592 0146,2593 5030

FH7:033-2592-0146, 2593 5030

POLICY SCNENRE

National Madiclaia
Polic 54501/48/14/g5RODa)77

ra-ariting
làccunation 16andar Sua Insuradi (R Ihisaata«/ Incention
S . a p nt the In<ured iiata af iAga IRe] atjon TExclusions jate:
Amnunt
Nn Person Rirth

2n08IDR
PURNENDII
ROY GENESIS
HOSPITAL
KOL.)
250A0 NORMAL PO;TEV
FKCLIISION
EWHANCED SUN
- NSUIRED
.E.F
20.07,2014)
50000 7500 NORMAL POLICY 20/07/2011
3AMTTTWT GHOSH 25/02/2011 3 Dauphter Infant
EXCLUSTONNE
INCL UDED
.E.F
20,7.2011
NORMAL POLICY
EXCLUSTON
ENHANCED SM
-TNSURED
.EF.
1 21.7,201i

MOAISIMT 6HOSH Noeinee Relaiion:

Nage of kopinee:
?

ist of .lauces, Endor segents, Varranties

Cjanse No. ieserintio
covarage has elaosad since incaQtion af tha
Tois inurance shall he axtended after 48 months of continuous
incurred relatin0 to the di seasa(s)/sjcknass/in iurv gentionad in tha roy
first nolicv to nav anv exnenses
ra-isting biseasa/Exciusjons and for consenuenCAS Attribut able therato or accalarated tharaby or arisine
fherefroe, in resnect on the resnective insurad narson

N.B- For /nereasiog 1 iha vaiiing geriods as in eyclusjons 4, 1/4,2/4,3 of the oolicy shall aooly on the anhancad SI as jt it
isanv policv, The henefit shal] accrue for PED or valtjno narjnd disAASAS oNcA tha nolicv with andancad I ragn] atas
the aitino ger ind noted in the golicy for thasa dj seasas,

Med Save Health (are TPA Itd R-11/9, Moan Cooneratjve Industrja) fstata, Badarnur. Nay helhi- 110044, Fav No
TPA Details
11-661i67
/1, AMAC ATREET R0 FL0R, CALCUTTA-10inI
PHGNE 2774-2132

011196

Drintad na 4L01Lh1i
 Printed on 1/07/7014 PR0e

aa gaaT NATIONAL INSURANCE COMPANY LTD.

(A Govt. of India Undertaking)
e7 aa:3, RHEA KE, aTB 700 071 National Insurance
Regd.& Head Office:3, Middleton Street, Kolkata-700 071
Barrackpore Branch Office : Atindra Complex, 1st Floor,
87/20. 9T 1 TS. 24 TUT (3TR). 87/20, Ghosh Para Road, 24 Parganas (N),
r. 700 120 Barrackpore, Pin 700 120
FFTT:033-2582-0146,2593 5030 Phone:033-2592 0146, 2593 5030

P TCY SCMERALE

Polier 154581/48/74/8500001977 National Mediciaia

TWGT TNE SS HEREGF. the endersigned heino duiv authorized hereunto sat his/ her hand at the office adóress nentionad abova, this
i/07/20i4. This seheduje. the attached oolicw. the cleases, the endor semants and the ool icv wor dings as avai ladle in the websi te
end topether as nne contract and anv word or exoression to vhich the specific meanino has heen attached in any oart of this
nnlicv or the ccheñu je chali bear the ca8e eeaning whereverit eav a00ear. It is varranted that IN CASE OF DISHONOR OF THE

PREMT CHE DE. TIS norMENT STANDS ALUTONATICALLY CANCELLED.

For and on hehaif of

dutv:
iehersean hetaiis: Rs.0.5) National insurance Company iinited
C

TRA Repn ho: 56 Authorized Sionatorv

c

Visit us et w.netionaiiecurancejndia.cog for inforaation on Products, Services and

6rievance Redressal

011193
 Printed on 4/07/74 hv h: bA Page

ivr gadra NATIONAL INSURANCE COMPANY LTD.

(A Govt of lndia Undertaking)
National Insurance
o7 51feTq3, Pfemea z, armM 700 071 Regd.&Head Office: 3, Middleton Street, Kolkata-700o 071
Barrackpore Branch Office:Atindra Complex, 1st Floor,
87/20, u TI ziE, 24 YTT (TT), 87/20, Ghosh Para Road, 24 Parganas (N),
r a , a 700120 Barrackpore, Pin 700 120
7HT: 033-2592-0146, 2593 5030 Phone:033-2592 0146, 2593 5030

PN TCY SCRE DOA F

Policy I56581/48/14/8500D61977 Nationai Mediciaja

PREMTUM CERTIFICATE

For the ourease of deduction uls R0 D of Inco8e Tax (Aaendeent) Act. 1986)

This is to certifv that SUBIR GHOSH has paid Rs, 4455

in vords) RIPEES FOlk THOUSAND FONIR HUWDRED FIFTY FIVE ONLY
Towar d's Prepiun for National Mediclaja Policy vide
Poiice bo. 154541/48/14/8500001972 for the Period fron 20/01/2014 to 19/07/2015
bw instrunent aueber 34387 dated /07/2014
Preniun Rs. 3965. service Tax Rs. 490
PavBERt received vide receint no. 15450182140000005512 dated 14/07/2014

For National insurance Coarany Liaited

IFDA Rep, ko: 58 Duly Constituted Authoritv

ate This Certificate aust be surrendered to the Insurance Connany for

issuance of fresh certifiçate in case of cancellation of the poiicy
ot any alteratlon in the Insurance affecting the 0ojicy,

011194