HDFC ERGO General Insurance Company Limited

2950203221174500000

Mr Junaid Um
Sajitha Manzil Padnekadappuram
Valiya Paramba Villege Padne
Near Ghss Kasargod
Kerala, 671312 , Contact No :
7034358445

Date : 06/01/2020

Dear Mr Junaid Um

Thank you for choosing HDFC ERGO as your preferred insurance partner. We welcome you to be a part of our family !
Your Health insurance policy reference no 2950203221174500000 is confirmed on the basis of the information and declaration given by you.
The details of coverage are mentioned in the enclosed policy schedule of insurance.

We value your relationship with us and assure you our best services at all times and we look forward to serve you.

Now you can view your policy details and health card at your fingertips. Download our Mobile App now and experience convenience today!!

For HDFC ERGO General Insurance Company Ltd.

Ankur Bahorey
Head - Retail Business Group

HDFC ERGO General Insurance Company Limited

Dear Junaid Um,

Subject : Certificate for the purpose of deduction under section 80 D of Income Tax (Amendment) Act, 1986

This is to certify that we have received an amount of ` 1,089.00 towards premium for Critical Illness Section of Certificate
No. 2950203221174500000 issued to Junaid Um for the period 06/01/2020 to 05/01/2024.
Note: This is subject to the provisions of Section 80D of income tax (Amendment) Act, 1986 as amended from time to time.

Date : 06/01/2020 For HDFC ERGO General Insurance Company Ltd.

Certificate Issuing Office: Mumbai

Duly Constituted Attorney

HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN:HDFPAIP10004V010910. Customer Service Address: D 301, 3rd Floor,
CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078.
165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service No : +91 22-62346234/+91-120 6234 6234 | www.hdfcergo.com
 HDFC ERGO General Insurance Company Limited
Certificate Of Insurance
Sarv Suraksha
( Sarv Suraksha Plus )

2950203221174500000
0
Policy No. :2950 2032 2117 4500 000 Issuance Date :06/01/2020 0
Period of Insurance : From 06/01/2020 20:23 hrs To 05/01/2024 Midnight
2
Invoice No. : 203221174500000 Premium Frequency :One Time 1
Proposer Name : Mr Junaid Um Territorial Limits :Worldwide
Mr Junaid Um
Sajitha ManzilPadnekadappuram Valiya Paramba Villege Customer Id :100957929541 PAN
Padne Near GhssKasargod Master Policy No. :2999201363863003
Kerala, 671312, Contact No : 7034358445 Master Policy Holder
:HDFC BANK LTD
Name

Payment Details : SL_ AL_1128_060120 , Date: 06/01/2020, Bank Name:Hdfc Bank Ltd
Email ID : JUNUALI143@GAMIL.COM
Insured Details
Insured’s Name Relationship Date of Birth Benefit
Junaid Um Self 29/05/1984 100%
Nominee Details
Insured’s Name Nominee Name Relationship Benefit
Junaid Um Rusna M Spouse 100%
Coverage Details
Coverage Premium (`) Sum Insured (`) Coverage Premium (`) Sum Insured (`)
Loss Of Job (3 EMI) 405 100,000 Critical Illness 1,089 100,000
Accidental Death 467 500,000 Credit Shield Insurance 778 500,000
Permanent Total Disability/ Permanent Partial Disability 623 500,000 Garage Cash 700 3,500
Accidental Hospitalization 311 100,000 Householders Coverage 516 150,000
The Policy Wording attached herewith includes all the standard coverage offered by the Company to its customers. Your entitlement for coverage/benefits shall be restricted to the coverage/benefits
as mentioned in this Certificate of Insurance issued to you. Please read the Policy Wording in conjunction with the Certificate of Insurance. For any clarification please call our toll free number.
Premium Details ( ` )
Basic Premium 4,889.00
Loadings 0.00
GST 18% : Central Tax 9% ( `440.05 ) + State Tax 9% ( `440.05) & Kerala Flood Cess at 1% ( `48.9 ) 929.00
Total Premium 5,818.00
Processing Centre 6th Floor, Leela Business Park, Andheri-Kurla Road, Andheri(E), Mumbai 400 059.
For Claim/Policy related queries call us at +91- 22 6234 6234/+91- 120 6234 6234 or Visit Help Section on www.hdfcergo.com for policy copy/tax certificate/make changes/register & track claim.
If the premium i s not realised the Certificate shall be void from inception.Consolidated stamp duty for this Insurance Policy i s paid by Demand Draft, vide
Receipt/Challan noCSD/195/2019/5101 dated 31/10/2019 as prescribed in Government of Maharashtra Order No. Mudrank-2017/CR.97/M-1, dated the 09th January
2018". , GST Registration No: 32AABCL5045N1ZH.GST for this invoice is not payable under reverse charge basis.
Branch :1st floor, kvr tower, south bazar,kannur kannur

Agent Name :HDFC BANK LTD For HDFC ERGO General Insurance Company Ltd.
Agent Code :201587086428 Tel No. : 91-22-61606161

* For description of coverages, kindly refer policy wording.

Duly Constituted Attorney

HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN:HDFPAIP10004V010910. Customer Service Address: D 301, 3rd Floor,
CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078.
165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service No : +91 22-62346234/+91-120 6234 6234 | www.hdfcergo.com