Address of Issuing Office : Address of Servicing Branch Office :

Reliance General Insurance Co. Ltd Reliance General Insurance Co. Ltd
Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Policy Servicing Branch address : Reliance Centre, South Wing, 4th
Santacruz (East), Mumbai - 400 055. Floor, Off. Western Express Highway, Santacruz (East), Mumbai
MUMBAI MAHARASHTRA 400055, INDIA
Branch Contact No. 022-33031000

Burglary and Housebreaking Insurance Policy

Master Policy No :
Tax Invoice and Date:
Date of proposal & declaration : 30/05/2019
Name of the Insured :
Communication Address &
place of Supply :
Period of Insurance :
GSTIN / UIN of Insured:
Financial Interest
Financier Name
920291929140000025 Policy Certificate No : 920291929111142554
Y053119001587 & 31-May-2019
Subhasish Patnaik
House linked with Utility Consumer No.11133000V1010484, NA, City : NA, State : ANDHRA PRADESH, PinCode :
999999,
Telephone No : 02222222222, Mobile No : 9040294704
, Email ID : refractory.drawing@gmail.com
From : 31/05/2019 To : 30/06/2019
NA
Financier Type Financier Address/City

Description and situation of the premises containing the property insured :

Address :
House linked with Utility Consumer No.11133000V1010484, Utility Board-apepdcl, City :NA, State : ANDHRA PRADESH, PinCode : 999999
Property Insured : Home Contents excluding Jewellary & Valuable
Sum Insured: INR 5,00,000/- (On first loss basis of 20% of full sum insured of INR 25 Lacs)
Extensions :

Special Conditions :
Accidental Death (AD)

if such injury shall within twelve calendar months of its occurrence be the sole and direct cause of the death
of the Insured Person

Permanent Total Disability (PTD)

Sight of both eyes / Physical separation of Two entire hands / Physical separation of Two entire Feet /

Physical separation of One entire hand and one entire foot / or of such loss of sight of one eye and such loss
of one entire hand or one entire foot
Premium Details Amount (Rs.)
Net Premium : 63.50
IGST : (18.00) 11.43
Total Premium : 75.00
GSTIN : 27AABCR6747B1ZG SAC : 997139
Description of Services :Other non-life insurance services (excluding reinsurance services)
Consolidated Stamp Duty Paid with Receipt No. CSD/10/2019/1896/19 Dated 23 Apr 2019 ** Not Applicable for the State of Jammu & Kashmir
Note : In the event of dishonor of cheque, this policy document automatically stands cancelled from inception, irrespective of
whether a separate communication is sent or not.
In witness whereof this policy has been signed at Corporate Office(Servicing) on 31-May-2019
This document shall be treated as a tax invoice as per rule 9(2) of the Goods and Services Tax invoice rule.
For any assistance with claims, please contact us on 1800 3009(toll free)/(022)4890 3009 or email us at services.rgicl@relianceada.com.
In case of a renewal, the benefits provided under the policy and/or terms and conditions of the policy including premium rate may be
subject to change.
Grievance Clause:-

Reliance General Insurance Company Limited. IRDAI Registration No. 103 Certified for Excellence - ISO 9001:2015
Registered Office: H Block, 1st Floor, Dhirubhai Ambani Knowledge City, Navi Mumbai 400710.
Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055.
Corporate Identity No.U66603MH2000PLC128300. UIN No: Page 1 of 2
RGI/UW/CO/2911/PS/1.0/010218
Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License
For resolution of any query or grievance, Insured may contact the respective branch office of the Company or may call at 1800 3009 or may
write an email at rgicl.services@relianceada.com. In case the insured is not satisfied with the response of the office, insured may contact
the Nodal Grievance Officer of the Company at rgicl.grievances@relianceada.com. In the event of unsatisfactory response from the Nodal
Grievance Officer, insured may email to Head Grievance Officer at rgicl.headgrievances@relianceada.com. In the event of unsatisfactory
response from the Head Grievance Officer, he/she may, subject to vested jurisdiction, approach the Insurance Ombudsman for the
redressal of grievance. Details of the offices of the Insurance Ombudsman are available at IRDAI website www.irda.gov.in or on company
website www.reliancegeneral.co.in or on www.gbic.co.in. The insured may also contact the following office of the Insurance Ombudsman
within whose territorial jurisdiction the branch or office of the Company is located. Office of the Insurance Ombudsman,3rd Floor,Jeevan
Seva Annexe,S. V. Road,Santacruz (W), Mumbai - 400 054. Tel.: 022 - 26106552 / 26106960 Fax: 022 - 26106052 Email:
bimalokpal.mumbai@gbic.co.in | Shri. A. K. Sahoo Office of the Insurance Ombudsman,Jeevan Darshan Bldg.,3rd Floor,C.T.S. No.s. 195 to
198,N.C. Kelkar Road,Narayan Peth, Pune – 411 030. Tel.: 020-41312555 Email: bimalokpal.pune@gbic.co.in
For Reliance General Insurance Company Limited

Duly Constituted Attorney(s)

Agent Code/Name: 17C37768 / ONE97 COMMUNICATIONS LIMITED

Reliance General Insurance Company Limited. IRDAI Registration No. 103 Certified for Excellence - ISO 9001:2015
Registered Office: H Block, 1st Floor, Dhirubhai Ambani Knowledge City, Navi Mumbai 400710.
Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055.
Corporate Identity No.U66603MH2000PLC128300. UIN No: Page 2 of 2
RGI/UW/CO/2911/PS/1.0/010218
Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License