niva P=) Health insurance Policyholder Name: MR. GANGARATU. Policy Number [seriasa0202200 Policyholder Address: NO W152 HM POTRAIT NEAR ANIINAYYA TEMPLE, Policy Commencement Date and Time| From 20/09/2022 00:00 Policy Expiry Date and Time [To 19/09/2023 28:59 JALLAHALL HINT TOWNSHIP BANGLORE 1, Plan Opted Famly Floater BANGALORE, [Policy Period Tear ‘BENGALURU, [Renewal ‘Payment Due Date [19/09/2023 KARNATAKA. 560013 Details of Bectronic insurance Account (eA) (tA Number None Insurance Repository Name [None Cover Detals Name of the insured Person(s) | BaseSum | Sumlnsured | Booster Benefit | Sum insured (Base Sum | Personal Accident Insured (in } Safeguard Gn Rs) | accrued (ins) | Insured + Booster opted Rs) Benefit + Sum insured Safeguard) (n Rs.) Mr. Gangaraju 5.00,000 0 ° 50,000 No Mis. Meghana Np No Ms. Nivith Raj No Mis Alshatha G No Premium Details Net Integrated | Central Goods and | State/UT Goods and | Gross Premium (Rs) Gross Premium (Rs) Premium/Taxable | Goods and | Service Tax (0.00 | Service Tax (0.00°%) {dn words) Value (Rs) | Service Tax ~” (8.00%) 1525800 | 2,885.54 0.00 0.00 15,638.00 | Fiteen Thousand Si Hundred ‘Thirty Nine Only Nominee Details Nominee Name Relationship with the Policyholder Meghana Np Spouse Intermediary Details Intermediary Name Intermediary Code Intermediary Contact No. Hdfe Bank Ltd. - BNK0090001 02261606161 Bnk0090001rival ‘a nor Seng Bach Deals vs Hapa Hearne Company ted | Lage teh Pak, Pot oD Scr 8, Nos ata Buh apr, Ur Pradesh Eten Opto ent etre Beta Parl Drea Perera Aen Cour Noted Stepan Noted asta Cash Noted Sar Heh Dose Manage) Nt Oped Sar Heh ete Car) Rotopt rect Boe Table? npn ae [eovered po Sum rd Day Ge Teac [covred upto Sum eed [erate eames Texrered upto San aoed Ten Hosp [Goered upto Som sed ers eatments [covered up oS red wi db i oR Ta one rb ug Pe palatine pen 0 Bo [cvred uo Sum ured Pot hoxton Medial xperes (18 Day [Gerad upto Sum sed lke nj Donor ape [Gered po sum sed Rinergny Aeecs [Goer pos 200 pr Ppt [Amine [Cases aim: Covered po Sum sured nbs dns Cvs p> ime ae esi {cored pio Sun bowed Rose eae Incase ofc fe yar, ease of 7 a exp as Sam ued maPoey arin upto 10 ae Sam bared as os dm reduce cunt CumulatheBoas y3%exping aeSr sed oo [teed statement op tbs Son red [Shred ccommndn Cah Boel 0 per dy ui B00 ea Chek For dete af ws ups. £50 a Fa een Nel Opn Toe oy cendion fr Wich platen Tne ea ene [count on tecwal premium ar mb op teppei or ard Peer the than an ge) "Theda of bet nd cane depp pao Al he bret aron pe Foc Tear bak. kerb ra neon Name ofthe sured Reson) Age nears) | redDOB | Gender | telatoap [Penta Does’ | Personal ating ered i Gage aioe | Mae | Ap Tome None TW Mogi ip aaa | Fema | Spe Tome te i Rana 1 owes | wae Son Tone Nene ‘iA [weenie | Fema | Danger Tome Nene Pema Eon a Pe ext edhe ou/sued Fran dcoveted bys dt mee eri) rst Noten no 1/2020: Cental Tx and Notion no 1/2020: Cerra a ah dated 21 March 200 vad with 42) of Po Nm or dt I ONO 4/56 rival Heath insuronce cst tls 2017, the oso Enoki QR code ae not appeal oa sara conan, he Eve mam and Rese has ot ‘ee itd ahs doce GT under FEM: NL sit: aan ON SC Coe ype of Seri 897193 /Gneal rane Series Na a ae Ce Gomer Sate Coe / Caer GSH N: 29 NA Pay eng lic: Del, Comte Stamp Diy depend spr he rer of Gvernmen of Natal Capt Teor of ai Pendle Loca: Ke et Deco Operations Customer Sere De 2005 2028 Ferand ont of Na Hap eas araceCmpan) ed (Germerlyknown a Max Bp eat surance Cod)