rellancoganeral.co.

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GENERAL
RELIANCE INSURANCE 022 4890 3009 )
74004 22200

Rollance Hoalth Gain Pollcy Schedul

Polleyholder Details
Poley Number 020222128280080290 ProponeliCovernote No 2032103102
Nane Customer 1D:
MR. PANKUAJ KUMAR

Gormeapondence Addrasa &Place of Supply:

D-10/300, GALI NO-10, DBLOCK, PHASEAYA NAGAR Polloy Servialng Branch:
SoUTH WEST DELH,SOUTH WEST, DELHI, Rellance conter,South wlng, 4th Floor, Of Westren exprese highway,
1004 Santaorux Eost MUMBAI MUMBAI MAHARABHTRA 400086

Contact No: 9953041219

Tax Involce No. &Date:
Emai-lD: pankal.kr.mca@gmalL.com R26032103192& 26/03/2021
GSTINIUIN of Pollcyholder:
Date of Birth
(DDMMYY: 11/12/1983
Gondor: Male
Plan Details
Cover Type Floater Tonure (Yoars)
Plan Name
Promium Payment Modo
PlanA Single
BusinossType Ronowal Provious Policy No
Policy Period Start Date: 01/04/2021 End Date
130322028280000415
31/03/2022 Renewable Date: 01/04/2022
Details of the tnsured
Name MR. PANKAJ MRS. RANJU MR. SATYAM
KUMAR MR. SHIVAM
KUMARI PANDIT KUMAR KUMAR

Gender Male
Female Male Male
Relationship Self Spouse Dependant Son Dependant Son
Date of Birth 12/11/1983
(DD/MMYYYY) 23/01/1986 18/10/2009 18/10/2009
Pre-existing Disease
Name NO NO
NO
NO

Pre-existing Disease
Since NA NA NA
NA

Insured with the

Company, Since
Base Sum Insured
(individual NA
NA
NA
Base Sum Insured 300000 NA
(Family Floater)
Cumulative Bonus NA
(Individual) NA
NA
Cumulative Bonus
Family Floaler) 200000.00
NA

VLE ID
VLE NAME
UIN
VLE Contact Number

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 RALIANCA GENERAL
9899007309
Arjun Kumar
18A39309

keluana5/0A0
HealtCan
No./PAN
POS UID Aadhaar
IntermediaryContact No.
Intermedlary Code
Intermediary Name
32 |ene
Amount()
Premium Details
250 ejuum
m

Baslc Premium
11626.00 bar
0.00
Loading: Underwrlting
Discount
Net Premium
0.00
11626.00
2092.68
emium ma
p

IGST (18.00%)
Total Prmdurn i e ab
GSTIN:27AABCR674781ZG,HSN: 9971
s 13719.00 Cmelo
services
Description of Services: Accident and health insurance

Nominee Details

RANJU KUMARI PANDIT Date Of Birth 23/01/1986 Relationship with proposer Spouse
Name

Address ofNominee D-10/30o,GALI NO-10, D-aLOCK, PHASE4, AYA NAGAR sOUTH WEST DELHI,SOUTH WEST,DELHI,10047

Benefit Table
Benefit Basis of Offering Benefit Basis of Offering
a-Doctor Anytime /Free Health Helpline: The
Hospitalisation Expenses Medical Expenses incurred as Inpatient Wellness
InsuredPerson shall have the option of
hospitalization Day care Treatment
Pre Hospitalisation Expenses Pre-hospitalization up to 60 days seeking medical advice from a Medical

Post Hospitalisation Expenses Post-hospitalization up to 60 days Practitioner through the telephonic or

Domestic Road Ambulance Upto Rs 1500 per Hospitalization online mode b- Health Portal: The

Donor Expenses Upto 50% of Base Sumlnsured subject to InsuredPerson shall have the option to
maximum of Rs 5 lacs access health related information and

Domiciliary Hospitalization Upto 10% ofthe Base Sumlnsured subject to a services through the Company's/designated
maximum of Rs 50,000 website

Cumulative Bonus 33 1/3 % increase in Base Sumlnsured for

every claim free year Max up to 100% of Base
Suminsured 33 1/3 % decrease in Base
Suminsured for every claim year Max up to
eamed Cumulative Bonus
Reinstatement of Base Sum Insured Once re-instatement upto 10% of Base Sum
Insured, subject to sublimit of 20% for
related lness/ injury

Call Option Once at the end of every consecutive 4 claim

Claim Servicing Guarantee
free years
Cashless Claims 1% for every delay of 6
hours beyond 6 hours of receipt of all
infomation /documents Re-imbursement
-1% for every delay of21 days beyond 21
days of receipt of all information/documents

Maximum -6% for a claim

Endorseiments

Reliance General Insurance Company Limited. IRDAI Registration No. 103. An ISO 9001:2015 Certified Company
Registered office: Reliance Centre,South Wing, 4thFloor,Off. Westem Express Highway,Santacruz (East). Mumbai- 400 055.
Corporate Office: Rellance Centre, South Wing, 4th Floor, off. Westem Express Highway, Santacruz (East), Mumbai - 400 055.
Corporate ldentity No.U66603MH2000PLC128300.UIN:RELHLIP21514Vo22021. RGI/MCOM/CO/2828/PSVer.1.5/010218.
Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License.

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