This Document is Digitally Signed

Signer: ATUL JERATH

Date: Thu, Jul 30, 2020 11:13:20 IST
Location: NOIDA
Reason: Signing Policy for OICL

CORONA RAKSHAK POLICY - ORIENTAL INSURANCE POLICY SCHEDULE

UIN: OICHLIP21064V012021

Policy No. : 462600/48/2021/1478 Prev. Policy No. : -

Cover Note No. : - Cover Note Date : -
Insured's Code : 109835368 Issue Office Code : 462600
Insured Name : abir infrastructure pvt ltd (GSTIN: 0) Issue Office Name : DO TANUKU (GSTIN:
37AAACT0627R4ZV)
Address : Snehalatha building , Somajiguda , Address : RASHTRA PATHI ROAD,
Ground floor , Hyderabad , beside TANUKU - 534211.
CM camp office , Snehalatha -
Complex, 6-3-871, ground floor, TANUKU ANDHRA PRADESH 534211
Greenlands Road, Begumpet,
Hyderabad, Telangana 500016
-
-
ANDHRA PRADESH
Tel./Fax/Email : / / 0 / NA Tel./Fax/Email : 08819-222167 / 222980 / 9440184967
/ 08819-224998 /
462600@orientalinsurance.co.in;
seshu.babu@orientalinsurance.co.in
Agent/Broker Details POSP/CPSC/MIC RO agent deatils
Dev.Off.Code :
Agent/Broker : LC0000000585 M/S NOVO INSURANCE BROKING SERVICES [P] LIMITED
Address : 7-1-621/S/402, SATYA SAI APTS,,SRINIVASA NAGAR COLONY,AMEERPET,HYDERABAD
TELANGANA - 500038,HYDERABAD,TELANGANA,500038
Tel/Fax/Email : ////

Period of Insurance : FROM 13:05 ON 29/07/2020 TO MIDNIGHT OF 09/05/2021

Collection No. & Dt. : DC_I_IND 9056002153 - 29/07/2020 GST INVOICE NO :371976909 UIN :0
Gross Premium : 9,472 GST 1705 Stamp Duty : .5 Total : 11,177

Co-insurance Details : Nil

TPA Details :
TPA ID YA0000000342
TPA Name M/S GOOD HEALTH INSURANCE TPA LTD
Address : SUITE 403-406A, 4TH FLOOR, ASHOKA MY HOME CHAMBERS, BEHIND ASHOK
BHOOPAL CHAMBERS, SARDAR PATEL ROAD, SECUNDERABAD, TELANGANA-
500003,MAIL@GHPLTPA.COM
Telephone No :
Toll Free No. :
FAX No. :
1800-425-3232, 1860-425-3232 Email

Number of persons covered 4

Place : TANUKU For and on behalf of

Date : 29/07/2020 The Oriental Insurance Company Limited

In case of any query regarding the Policy please call Toll

Free No. 1800 11 8485 and 011 33208485. Authorised Signatory

CIN: U66010DL1947GOI007158 All the Amounts mentioned in this policy are in Indian Rupee Page 1 of 4
IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in
 This Document is Digitally Signed

Signer: ATUL JERATH

Date: Thu, Jul 30, 2020 11:13:20 IST
Location: NOIDA
Reason: Signing Policy for OICL

Attached to and forming part of policy number 462600/48/2021/1478

Discounts allowed: NO

Particulars of the Persons covered :

Sr. Name of The Date of Age Relationship

Gender Pre-Existing Diseases Sum Insured
No. Persons Birth With
(INR)
Proposer

1 REVATHI F 27/08/1982 37 Self 2,50,000

VINNAKOTA
2 ANKA BABU M 05/08/1969 50 Spouse 2,50,000
VINNAKOTA Employed
3 MEGHANA F 22/03/2001 19 Dependant 2,50,000
VINNAKOTA Child
4 SREE HARSHA F 24/10/1999 20 Dependant 2,50,000
VINNAKOTA Child

Nominee Details
Name Of the Nominee Relationship With the Insured Age Of the Nomine M/F/TG*

ANKA BABU VINNAKOTA Spouse Unemployed 50 M

REVATHI VINNAKOTA Spouse Employed 37 M

REVATHI VINNAKOTA Dependant Child 37 F

REVATHI VINNAKOTA Dependant Child 37 F

Total Premium in words : Indian Rupees Eleven Thousand One Hundred Seventy-Seven Only

The insurance under this policy is subject to conditions, clauses, warranties,endorsements as per forms attached.

In the event of a claim under the policy exceeding Rs. 1 lac or a claim for refund of premium exceeding Rs. 1 lac,the insured
will comply with the provisions of the AML policy of the Company.The AML policy is available in all our operaing offices as
well as Company's website.

Place : TANUKU For and on behalf of

Date : 29/07/2020 The Oriental Insurance Company Limited

In case of any query regarding the Policy please call Toll

Free No. 1800 11 8485 and 011 33208485. Authorised Signatory

CIN: U66010DL1947GOI007158 All the Amounts mentioned in this policy are in Indian Rupee Page 2 of 4
IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in
 This Document is Digitally Signed

Signer: ATUL JERATH

Date: Thu, Jul 30, 2020 11:13:20 IST
Location: NOIDA
Reason: Signing Policy for OICL

Attached to and forming part of policy number 462600/48/2021/1478

Warranted that in case of dishonour of premium cheque(s) the Company shall not be liable under the policy and the policy
shall be void abinitio (from inception).

"We at Oriental continuously strive to ensure that you get the best possible treatment from our network hospitals.
Please contact your TPA or any of the Oriental offices for our preferred hospitals in your area before going for a
treatment. This will help us serve you in the best possible manner"

Policy History Data

Policy No. Period From Period To Insurer Name Sum Insured
Claim History Data

Policy no. Claimant Nam Claim No. Claim OS Claim Paid

DISCLAIMER OF CLAIM: If the Company disclaims liability and communicates in writing to the Insured in respect of the
claim and such claim has not within 12 calendar months from the date of such disclaimer been made the subject matter of a
suit in a Court of law, then the claim shall for all purposes be deemed to have been abandoned and shall not thereafter be
recoverable hereunder.

GRIEVANCE REDRESSAL: When the Company repudiates a claim if not payable under the policy, the Company shall
communicate the reasons for repudiation in writing to the Insured. In case of any grievance related to the policy or a claim
thereunder, the Insured shall have the right to appeal / approach the Customer Service Department of the Company at its
policy issuing office, concerned Divisional Office, concerned Regional Office or of the Head Office, situated at A-25/27, Asaf
Ali Road, New Delhi-110002. E-mail id is csd@orientalinsurance.co.in. Exclusive e-mail id for grievance redressal of senior
citizens is oiclhealthservice@orientalinsurance.co.in.
If the insured is not satisfied with the reply of the Customer Service department under above, he may register complaint with
IRDAI at www.igms.irda.gov.in, or at 1800 4254 732; or approach Insurance Ombudsman, established by the Central
Government for redressal of grievance.

In witness whereof the undersigned being authorised by and on behalf of the Company has/have herein to set his/their hands at DO
TANUKU (GSTIN: 37AAACT0627R4ZV) on 29-JUL-20.

Place : TANUKU For and on behalf of

Date : 29/07/2020 The Oriental Insurance Company Limited

In case of any query regarding the Policy please call Toll

Free No. 1800 11 8485 and 011 33208485. Authorised Signatory

CIN: U66010DL1947GOI007158 All the Amounts mentioned in this policy are in Indian Rupee Page 3 of 4
IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in
 This Document is Digitally Signed

Signer: ATUL JERATH

Date: Thu, Jul 30, 2020 11:13:20 IST
Location: NOIDA
Reason: Signing Policy for OICL

Attached to and forming part of policy number 462600/48/2021/1478

1. Notification of Claim: within 15 days from the date of occurrence of the event / diagnosis of COVID.
2. Submission of claim documents: Within thirty days of date of discharge from hospital following positive diagnosis for
COVID.
3. For complete details please refer policy document.
4. The Company shall settle or reject a claim, as the case may be, within 30 days from the date of receipt of last necessary
document.

Entered By : A S V SESHU BABU

For and on behalf of
Examined By : A S V SESHU BABU The Oriental Insurance Company Limited

Policy Printed By : OICL IP :

Policy Printed On : 30-JUL-20 11:12:19 MAC :

Authorised Signatory

Place : TANUKU For and on behalf of

Date : 29/07/2020 The Oriental Insurance Company Limited

In case of any query regarding the Policy please call Toll

Free No. 1800 11 8485 and 011 33208485. Authorised Signatory

CIN: U66010DL1947GOI007158 All the Amounts mentioned in this policy are in Indian Rupee Page 4 of 4
IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in