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HDFC ERGO General Insurance Company Limited HDFC ERGO ‘my: health Medisure Classic Insurance Policy No. 2857 2019 16949400 000 Policy Schedule sees MOON [Proposer Name [MR KRIPWAL PARDESHI Pana. Premium Frequency | Yeary (ovr ees) LUOMINAGAR NAVAGARIDROOLI ROWD NEAR Permaner | 16 LANG NAAGARM DIRDOL ROAD NEAR RAARAYANA PARC Place of Supply | PAMATANA PARK LOHNA UDHNA S10 CHORYASI ‘adress UGENAUDHNASO CHORYASL ‘SURAT GUIARAT:19210 - | SURAT.GUIARAT:12"0. Mebane [essnaT0809 Phere [EMail [RRUNACNECHIDBCAIN COM “Paley Type Peredefnaurance | FonOaie 8 Tew | TORATOOOT Ns | vs ie & Te MORO | Pobey tauanea Oke | D00NR0IT Prewous Pley Narber ‘es ecnasseroato "Wane ofRccm Reet Sub Gnas opie Ne insured Person's Detals & Sum Insured ‘urershane | Reasonwan | Gender) Dano! WorneeRire Nemnee | TtPetey | Smid | C8 Ancint | Pre eng eal ‘Dax Su re or Cia Une ple poly hots ith Reionstip | Inception ic) o RaeNoRASA I | eeeraen T 1 1 = [me usm ovo Fence omen [secs | om ‘SEETABEN Rajendran ame a (ay ener Forme |sooeiees | omer | tecaanie cs Basic Covor Raa Rertloarng_ as prac kid io (ol Sum haired (excudhg aultie Ears) per iy ubedio a rain lS ‘000: per uy ICU Rencoang a par sales 2st Sam esate (ecu cure bars) pa ay bjt are Mca als Su raed ards asari Moeplsahon ay wha eal Suv isaac eu ‘rom ue 10% ol Sum bute rR 0 00 for onal dry and uo 20% o Sum srr Ps 401000 1 a Camsaeah Seton cing charger New Bor Cons, hs coverage subject io wang pedal 48 merthaclconimucus ovenge cra po Rs 25,80 fr aed esimerts "Cover ree comnuireeas LopionalCovers(on payment a acetone! premium i Opto) sar ots Dale i Sus Fred bled Creal reise | saa a Sn res Value Aas Ri Up ay cang For dy day SD (cans oy) Mian ups Ri 100" pet hsptalzatn Fs 5,00 when oepiabaion exceed 10 dy ‘he evr years of cen lm res renewals, rl surineured Peso ut ammum of ef ape Sim reared ‘luda tune bonus. This aval pet Insrensted Person case fan ida Poy an er Se uk Speder eet ThePoiyerdeg staid beni celle sandaréconrge cede Cangany es axons You widen cwayebeelis tube mice ae oneageteeas mesic (Ply Sotto nt ys Poe edb Ply len noon wth he Poy Ste Ferry driaten seca beer ce =a | = [Tom Premon oxousra Tas 43200 oe : 7 aay | ae [Tomi Premium: 1616.00" ST ai =o ar 955 poowzeir ale Bank is terol Ho. orBTeDS-o0000 7 HEN Code | 6071 [ForCianSerdces | Phone 18002786700 [Faxno, [Wr eOBaD Emel | feaitcaimedhaberocm [Processing Genie —|HOFC ERGO General rsiance Capary Lid fc, Tower 1, Sie Pat, C28 Sedar-@noxe 201301 | oranjotierqurycaititeo 18002700700 consis wlexe@clowe oom rgb wwwihdleerpe om Augen Copsnte ie: te, 118 Buty Raat, T.Path Nap. Chto aa = S000 okey surest Senin Aes 0 Fes, ela Bess Pt acer Ks Ran, ret E) Mant 400 (58 Tel Fee: HOETOGTO (cen nda ce Fa: 9122 OD EN |arhciwrpacm| aw etergacon CO: VULOAMCATPLEITHE IRDAL Rego. 168 Frm OC carat nase ita basen 216 LAT Grater Ce nee apron 13.2048

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