Dated: 26-Nov-2022

GNANESH S
IST FLOOR OUTH CORNER 205 NAIDU LAYOUT AREHALLI SUBRAMANYAPURA POST
BANGALORE, BANGALORE
KARNATAKA, 560061

Dear Sir/Madam,
Subject: Required Documents

Claim No. : 202220086138 UHID No. : RD9M22000047E1

Policy No. : 140132228430000003 Policy Validity : 18 Jan 2022 to 17 Jan 2023
Policy Holder / Employee Name: GNANESH S Employee No. (if any): APM135
Name of the Patient : BOY BABY Hospital Name : PRAKRIYA HOSPITAL
REPAIR, INITIAL INGUINAL HERNIA, PRETERM INFANT (LESS THAN 37 WEEKS GESTATION AT BIRTH),
Ailment / Diseases : PERFORMED FROM BIRTH UP TO 50 WEEKS POST-CONCEPTION AGE,WITH OR WITHOUT
HYDROCELECTOMY; REDUCIBLE
DOA : 06 Sep 2022 DOD : 29 Sep 2022

At the outset we are concerned to note that GNANESH S are unwell. We wish speedy recovery and good health. In this regard, we request you to please
submit the following information/documents to enable us to proceed further with your claim:
1. Any important claim document not provided(Claim form,Cancel check,ID proof,Original Discharge summary,Original final bill,Original investigation
reports,Present Consultation papers,Medical bills,Paid Receipt) - Kindly provide 1) complete Indoor case papers with Drug administration sheet of
present hospitalization and 2) PAN card copy of the insured.
As part of digitization and ongoing pandemic situation, kindly share the scan copy of original documents with in 7 (Query Response period) days instead
of sending through courier , so that we can proceed further and process claim.
Please note that conclusion regarding the eligibility of coverage / admissibility of claim, amount can be decided once we have a full set of original and
required scan documents.
For any assistance, please contact us at the address/email mentioned below or on our toll free helpline.
Please quote Claim No.: 202220086138 in all your future correspondence.
Yours Sincerely,
Reliance General Insurance Co. Ltd.

Important Note: This is an electronically generated document and requires no seal / stamp.

Note :
Reliance General Insurance company limited will reserve the rights to seek all the original documents in physical form for a period of one year from the date
of claim submission.
Reliance General Insurance company limited has right to take the refund of entire claim amount to the insurer if any misrepresentation/concealment of
facts by the claimant, related to claim/hospitalization. Also, the insurance company may take legal action, as deemed fit, if any discrepancy found in the
claim.