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    This certificate confirms that Vishal Purohit paid an annual premium of Rs. 20,805 for a health insurance policy with ICICI Lombard from November 6, 2021 to November 5, 2022. The policy covers hospitalization expenses of up to Rs. 25 lakhs. ICICI Lombard received the payment on November 4, 2021. This health insurance premium qualifies for a tax deduction under Section 80D of the Indian Income Tax Act.

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    This certificate confirms that Vishal Purohit paid an annual premium of Rs. 20,805 for a health insurance policy with ICICI Lombard from November 6, 2021 to November 5, 2022. The policy covers hospitalization expenses of up to Rs. 25 lakhs. ICICI Lombard received the payment on November 4, 2021. This health insurance premium qualifies for a tax deduction under Section 80D of the Indian Income Tax Act.

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    20 views1 page

    Insurance

    Uploaded by

    zabiulla m
    This certificate confirms that Vishal Purohit paid an annual premium of Rs. 20,805 for a health insurance policy with ICICI Lombard from November 6, 2021 to November 5, 2022. The policy covers hospitalization expenses of up to Rs. 25 lakhs. ICICI Lombard received the payment on November 4, 2021. This health insurance premium qualifies for a tax deduction under Section 80D of the Indian Income Tax Act.

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    Tax Certificate

    To
    VISHAL PUROHIT
    M Shabana Azmi
    NO 23,15TH
    #2000 ,1stMAIN
    MainNANJUNDESWARA,17D CROSS,LAYOUT,JP
    Road , 6th cross , Kengeri, upanagara , banglore
    NAGAR 5TH PHASE,JP
    Karnataka , 560060 NAGAR 5TH PH,BANGALORE
    BANGALORE
    KARNATAKA - 560078
    ANNUAL
    Subject: Premium certificate for the purpose of deduction under section 80D of Income Tax
    Act, 1961 and any amendments made thereafter.

    Dear M Shabana
    VISHAL Azmi
    PUROHIT, ,
    This is to certify that the Company has received the premium dated Nov 04, 2021 for Health
    insurance coverage under "Health Insurance Policy" with the following details.

    Policyholder's VISHAL PUROHIT


    M Shabana Azmi 4015i/IDOPD/209346525/ Policy Number
    Name 01/000
    Policy Start DateNov 06, 2021 Policy End Date Nov 05, 2022
    Plan Name IDIGITALHEALTHYU_OPD Total Premium Paid 20805
    _5L_7L_TO_25L_2A+1C (`)
    GSTIN Number GSTIN Reg.No (ICICI 29AAACI7904G1ZJ
    (Customer) Lombard)
    Servicing Branch Bangalore Servicing Branch Second SVR Complex
    Name Address Hosur Main road
    Bangalore Karnataka
    560068

    Premium Details (`)


    CGST SGST
    Basic Premium Total Tax Payable Total Premium
    % ` % `
    17631.36 9 1586.82 9 1586.82 3173.64 20805
    Financial Year Amount (`)
    2022-2023
    2021-2022 20805.00
    The product is eligible for deduction u/s 80D of the Income Tax, 1961 and any amendments
    made there to.

    Note: This certificate must be surrendered to the Insurance Company in case of Cancellation of
    the Policy. In the event of incorrect representation of this declaration, the liability shall be upon
    the policyholder.
    109/20150914/284

    ICICI Lombard General Insurance Company Limited


    IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 ICICI Lombard Group Health Insurance UIN - ICIHLGP02001V030102
    Mailing Address: Registered Office: Toll free no.: 1800 2666
    ICICI Lombard General Insurance Company Limited, ICICI Lombard House, 414 Veer Alternate No.: +918655 222 666 (chargeable)
    Interface Building No.: 16, 601 / 602, 6th Floor, New Savarkar Marg, Near Siddhi Vinayak Email: customersupport@icicilombard.com
    Link Road, Malad (West), Mumbai - 400 064. Temple, Prabhadevi, Mumbai - 400 025. Website: www.icicilombard.com 3/5

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