PA01010104629754

15-11-2022

Mrs RAMANI R
NO 4/233
KEEZHANAGAI NEDUVAKKOTTAI
SERANKULAM
MANNARGUDI
Mannargudi - 614014

HDFC LIFE COVER NOTE

Dear RAMANI R,

Thank you for choosing HDFC Life as your preferred insurance solution provider.

We confirm the receipt of your proposal form and would like to inform you that the risk coverage on the Life
Assured shall commence after acceptance of the risk by the company.

Summary of Proposed Policy:

Proposal No. 04629754

Name of the Proposed Life Assured CHARUGESH R
E-mail Address r.r178084@gmail.com
Telephone Number(s) 9865165509
Date of Birth of Life Assured 20-06-2006
Name of the Nominee(s)

Premium
Policy payment Modal
Sum Premium Payment
Plan Name term Term Premium
Assured (`) (`) Frequency
(Years) Frequency- (Yearly) (`)
(Years)
E50-HDFC Life Sampoorna
381958 59 10 62700 Yearly 60000
Jeevan 75
Agent Code:60559835 Agent Telephone: 9865165509 Agent Name: RAMANI S

Call : 1860-267-9999 (TOLL FREE); 022-68446530 (Std Charges apply) Email : service@hdfclife.com Visit : hdfclife.com

Registered Office: Lodha Excelus, 13 Floor, Apollo Mills Compound, N.M. Joshi Marg, Mahalaxmi, Mumbai 400 011 Tel No : (022) 67516666
th

IRDAI Registration No. 101 CIN: L65110MH2000PLC128245.

 PA01010104629754

Payment Summary:
Receipt No(s): 98182765
Mode of payment Online Transfers
Amount `62700
Transaction ID OT038663882
Total amount in words `62700 Sixty Two Thousand Seven
Indian Rupees Hundred

Please get in touch with us for any further assistance.

We hope to serve you again.

Yours sincerely,

Customer Services Team

HDFC Life
This is a system generated letter and requires no signature.

Points to remember:

1. This cover note is an acknowledgment of your proposal for HDFC Life Policy and shall be valid till the acceptance /
rejection of the risk by the company.
2. Acceptance of your proposal is subject to the verification of the documents submitted and on confirmation of the
details as stated by you in the proposal form. The company reserves the right to call for additional documents /
information from you if deemed necessary.
3. Please note that the original policy bond shall be dispatched to you after the acceptance of the risk by the company.
If you do not receive the Policy bond within 30 days from the date of this cover note, contact your advisor or visit the
nearest branch of HDFC Life to know the status of your proposal.
4. If you have opted for/hold an e-insurance account/policy, your new policy details will be automatically linked to your
existing e-insurance account. Physical copy of Policy Bond will not be issued. To view policy details login to your
e-insurance account.
5. In case the Policy gets cancelled, the premium amount paid by you towards the proposed policy shall be refunded
without any interest.
6. In case of dishonor of the premium cheque or non- production of information or production of incorrect information
or requirement for any additional documents, this document automatically stands cancelled from inception.
7. Premium amount provided to you may vary after underwriting evaluation of all the information provided to us.
8. Goods & Services Tax (GST) or any other form of taxes including applicable cess or charges will be additionally
charged as per prevailing tax laws and regulations notified by the Government of India from time to time.

Call : 1860-267-9999 (TOLL FREE); 022-68446530 (Std Charges apply) Email : service@hdfclife.com Visit : hdfclife.com

Registered Office: Lodha Excelus, 13 Floor, Apollo Mills Compound, N.M. Joshi Marg, Mahalaxmi, Mumbai 400 011 Tel No : (022) 67516666
th

IRDAI Registration No. 101 CIN: L65110MH2000PLC128245.