Samuel 80 D

Simplex|Tray1S
BlueDart / 39071258240 / M-662
Policy No. : 7000065113 00

Name : SAMUEL RAJ PRABHUDAS
Address : DNO172, PHASE2, USHODAYA ENCLAVE
MADEENAGUDA
MIYAPUR
HYDERABAD
TELANGANA -500049
7793932345
Insurance is the subject matter of the solicitation. For more details on risk factors, terms and conditions, please read sales brochure carefully before
concluding a sale.
TATA AIG General Insurance Company Ltd. Regd. Office: 15th floor, Tower A, Peninsula Business Park,Ganpatrao Kadam Marg, Off Senapati Bapat Marg, Lower Parel,
Mumbai400013. IRDA Registration No.108, CIN No : U85110MH2000PLC128425, PAN : , UIN No : TATHLIP21257V022021
Website: www.tataaig.com 24X7 Tollfree Helpline 18002667780 Email:customersupport@tataaig.com
Policy No. 7000065113 / M-662 Page No. 1
Simplex|Tray2S
Intermediary name : TATIPALLY VIKRAM

Policy
Schedule } Intermediary code : AGINAWKPT8763H
Intermediary contact no. : 9010967646(mobile or landline)
Issuing Office : HYDERABAD
Client Id : 6108263081
Proposal no : IDV000134191
Policy holder’s name : SAMUEL RAJ PRABHUDAS
Policy holder’s address : DNO172, PHASE2, USHODAYA ENCLAVE

MADEENAGUDA
MIYAPUR
HYDERABAD
TELANGANA-500049
7793932345
Insured GST No :
Place of Supply : TELANGANA
Supply Code : 36
Policy Number : 7000065113 00
Product name : Tata AIG MediCare Premier
Plan type : Individual Basis
Policy period : From 19/04/2022 00:00 hrs to 18/04/2024 on 11:59 PM
Business Type : NEW BUSINESS
Policy Tenure : 2 Year
Insured Persons Details :
Member Insured Insured Date Age Relation- Restore Sum Cumu- Accidental
ID person’s with TATA of Birth ship to Benefits Insured lative Death
name AIG General proposer % (Rs.) Bonus (Rs.)
Insurance (Rs.)
Co. Since
IDV0001341910 SAMUEL RAJ 19/04/2022 19/06/1992 30 Self 100 0.00

2,500,000.00 2,500,000.00
1027 PRABHUDAS
*For Family Floater policy, Sum Insured and cumulative bonus floats among the insured members of the family as mentioned above. This shall not be
applicable for newly added members in this policy.
# Sum Insured mentioned is excluding cumulative bonus. Earned cumulative bonus is separately mentioned
Nominee Details for Proposer:
Insured Name Nominee Name Relationship to Proposer
SAMUEL RAJ PRABHUDAS VYDEHI KAVALA WIFE
The nominee must be an immediate relative of the policyholder. For all other insured persons the policyholder shall be the nominee.
concluding a sale.
Simplex|Tray2S
Benefits table
Net Premium: (Rs) 24578.00
Cover Coverage
Discounts: (Rs) 0.00
In-Patient Treatment Upto Sum Insured Loading: (Rs) 0.00
UGST/SGST (9%): (Rs)
Pre-Hospitalization expenses Upto 60 days
CGST(9%): (Rs)
Post-Hospitalization expenses Upto 90 days
IGST(18%): (Rs) 4424.04
Day Care Procedures Upto Sum Insured Kerala Flood Cess @ 0 % 0.00
(Rs)
Organ Donor Upto Sum Insured Gross Premium: (Rs) 29003.00
Domiciliary Treatment Upto Sum Insured Gross Premium amount (in words) : Rupees Twenty Nine
Thousand and Three and Paise 00 Only
Global cover Upto Sum Insured
Bariatric Surgery Cover Upto Sum Insured
In-Patient Treatment - Dental Upto Sum Insured
Restore benefit Upto Sum Insured Claim Servicing Details:
n Name : TAGIC Health Claims
AYUSH Benefit Upto Sum Insured
n Website: www.tataaig.com
Upto Rs. 5000 per
Ambulance Cover n Email: healthclaimsupport@tataaig.com
Hospitalization
n Toll Free: 1800 266 7780 or 1800 229 966 (For
Rs. 50,000 in case of
birth of boy child;
Senior Citizens)
Maternity Cover Claims TATA AIG General Insurance Company
Rs. 60,000 in case of n
birth of girl child Administrator Limited,

Address: 5th and 6th Floor, Imperial Towers,
New Born Baby Cover Upto Rs. 10,000
H.No 7-1-6-617/A, GHMC No - 615,616,
Upto Rs. 10,000 in Ameerpet, Hyderabad – 500016, Telangana.
case of boy child;
First year vaccinations
Rs. 15,000 in case of
girl child
Upto 1% of Sum
Health Checkup Insured; max. Stamp Duty Registration Details
Rs.10,000 The stamp duty of Rs.50.00/- paid in cash or demand draft or
Vaccination cover Upto Sum insured by pay order,vide Receipt/Challan
50% of actuals;
no:LOA/CSD/318/2022/1601 dated the 08/04/2022
Hearing Aid
maximum Rs.10,000
0.25% of base Sum
Daily Cash for choosing For Tata AIG General Insurance Co. Ltd.
Insured; maximum
Shared Accommodation
Rs. 2000 per day
0.25% of base Sum
Daily Cash for Accompanying
Insured; maximum
an Insured Child
Rs. 2000 per day Authorized Signatory
Prolonged hospitalization benifit 1% of Sum Insured In the event of non-realization of premium, the
Company shall not be liable under the policy and the
High End Diagnostics Upto Rs.25,000 policy shall stand cancelled ab initio (from inception).
Consumables Benefit Upto Sum Insured

Policy Servicing Address :
OPD Treatment Upto Rs. 5,000
4th Floor, Block -A, My Home Tycoon, Kundanbagh,
Emergency Air Ambulance Cover Upto Rs. 5,00,000 Begumpet Hyderabad 500016 Tel No: 040-66024800 Fax
No: 040-66024888
Compassionate travel Upto Rs.20,000
Second Opinion Covered
OPD Dental Upto Rs. 10,000
100% of base Sum
Accidental Death Benefit
Insured
concluding a sale.
Simplex|Tray2S
Certificate of Premium payment for the purpose of declaration under Section 80 D of Income Tax
(Amendment) Act, 1961*
Date:20/04/2022
PolicyNumber:7000065113
CustomerName:VENUGOPALARAO POTAVARAPU
GSTIN no.:
Dear Sir/Madam,
Sub:TaxBenefitLetterforTataAIGMediCarePremierpolicyno.7000065113
This is to certify that premium amount of Rupees Twenty Nine Thousand and Three Only for health insurance
Policy No 7000065113 issued to VENUGOPALARAO POTAVARAPU for the period 19/04/2022 to 18/04/2024 has been paid.
Receipt Illustration
Receipt ID. Name of Payer Mode of payment Amount paid

106001030879702 VENUGOPALARAO POTAVARAPU Online 29 003.00
Total Amount Paid 29 003.00
Premium illustration (Member wise)

Total member premium paid
Member ID Name of Member Relationship with Policyholder (Including Taxes & Loading)
IDV00013419101027 VENUGOPALARAO POTAVARAPU Self 29 003.00

Total Premium Paid (Inclusive of Loading & Taxes collected) 29 003.00
Please feel free to get in touch with us for any further help or queries at our 24x7 Helpline 18002667780
(Toll-free) or email us at customersupport@tataaig.com
We assure you of our best services at all times.

Regards,
For Tata AIG General Insurance Company Limited
Authorized Signatory
DateofIssue:20/04/2022
Place of Issue:HYDERABAD
*Note
1. Tax deductions can be claimed subject to the provisions prescribed in the relevant sections of the Income-tax Act, 1961 as
amended from time to time.
2. Premium paid in advance will be applied to the policy on premium due date.
3. This premium paid certificate is conditional upon credit in company's account post clearance of the instrument/facility
including electronic mode.
4. For any confirmation / impact analysis, customer is advised to refer the matter to his/her Tax consultant.
5. This certificate must be surrendered to the company in case of cancellation of this policy. In the event of incorrect
representation of this declaration the liability shall be upon the policyholder/payer.
concluding a sale.
Simplex|Tray2S
Receipt } Receipt No. : 106001030879702

Receipt Date : 19/04/2022
Policy No : 7000065113 00
Received with thanks from VENUGOPALARAO POTAVARAPU a sum of Rs.29003.00 Rupees Twenty Nine Thousand
And Three Only Online
Gross Premium (`) Utilized from the receipt for policy (`) Balance (`)
29003.00 29003.00 0.00
Tax Benefit
Letter } Certificate for the purpose of deduction under Section 80 D
of Income Tax (Amendment) Act, 1986*
This is to certify that the Proposer has paid Rs 29003.00 (Twenty Nine Thousand Three Rupees only.) towards
premium for health PolicyNo 7000065113 issued to VENUGOPALARAO POTAVARAPU for the period 19/04/2022 to 18/04/2024
For Tata AIG General Insurance Co. Ltd.
Authorized Signatory
Date of Issue : 21/04/2022
Place of Issue : HYDERABAD
* Note
1. This is subject to the provisions of section 80D of the Income-tax Act,1961 as amended from time to time.
2. This certificate must be surrendered to the company in case of cancellation of this policy. In the event of incorrect representation of this declaration the liability shall
be upon the policyholder.
3. This certificate will not be issued if the premium payment has been made in cash/ demand draft.
*Tax benefit is available to the Premium payer. Tax benefits are not applicable on premium made in cash. The qualifying amounts under section 80D for self, spouse and
dependent children is Rs. 25,000. In case the proposer is aged 60 years or more during any time of the financial year, the qualifying amount shall be Rs. 50,000.
Additional deduction is available if premium is paid on behalf of the parents of the proposer. However, the aggregate deduction for the premium paid for self, family and
parents will be restricted to Rs. 50,000. The premium paid would be allowed as a deduction from the total income of the Proposer/ Assessee. The Porposer/ Assessee is
requested to consult his/ her tax consultant prior to taking deduction.
Note:
1. This is a computer generated receipt and does not require a signature.
2. Upon issuance of this Receipt, all previously issued temporary receipts, if any, related to this Policy shall be
considered null and void.
3. Amounts received by cheque shall be subject to realisation.
4. Any amount received in excess of the Premium is being/shall be refunded by the Company.
Revenue (consolidated) Stamp Duty duly paid vide challan No.LOA_NO.CSD/270/2022/727 date for applicable cases.
TELANGANA. Service Accounting Code : 997133
concluding a sale.
VENUGOPALARAO POTAVARAPU, 28years, Male
Policy No. : 7000065113
M-662 ( 1 to 1 )
Valid From : 19/04/2022
Member ID : IDV00013419101027
Simplex|Tray2S
Annexure to customer information sheet(CIS)- Benefit illustration in respect of policies offered on individual and family floater basis.
Age of the Coverage opted on individual Coverage opted on individual basis covering Coverage opted on family floater basis with
members basis covering each member of multiple members of the family under a single overall Sum Insured(only one sum insured
insured the family separately(at a single policy(Sum insured available for each member of available for entire family)
point of time) the family)
Premium (`) Sum Insured (`) Premium (`) Discount if Premium Sum Premium or Floater Premium Sum
any after Insured Consolidated discount after Insured (`)
Discount (`) premium for if any discount
(`) all members (`)
of the family
(`)
28 24578.00 2500000.00
Total Premium for all members of the Total Premium for all members of the family is Total Premium when policy is opted on floater
family is Rs 24578.00when each Rs_________ when they are covered under a single basis is Rs__________
member is covered separately policy
Sum Insured available for each Sum Insured available for each family member is Sum Insured of Rs____________ is available for
individual is Rs 2500000.00 Rs_________________. the entire family
Note: Premium rates specified in the above illustration shall be standard premium rates without considering any loading. Also, the
premium rates shall be exclusive of taxes applicable.
concluding a sale.

Samuel 80 D

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Samuel 80 D

Uploaded by

Copyright:

Available Formats

Simplex|Tray1S

BlueDart / 39071258240 / M-662

Policy No. : 7000065113 00

Intermediary name : TATIPALLY VIKRAM

Policy holder’s address : DNO172, PHASE2, USHODAYA ENCLAVE

IDV0001341910 SAMUEL RAJ 19/04/2022 19/06/1992 30 Self 100 0.00

birth of girl child Administrator Limited,

Consumables Benefit Upto Sum Insured

Receipt ID. Name of Payer Mode of payment Amount paid

Premium illustration (Member wise)

IDV00013419101027 VENUGOPALARAO POTAVARAPU Self 29 003.00

We assure you of our best services at all times.

Receipt } Receipt No. : 106001030879702

29003.00 29003.00 0.00

For Tata AIG General Insurance Co. Ltd.

TELANGANA. Service Accounting Code : 997133

Policy No. : 7000065113

You might also like