THE NEW INDIA ASSURANCE CO. LTD.

(Government of India Undertaking)

THE NEW INDIA ASSURANCE CO. LTD.

REGISTERED & HEAD OFFICE:87,MAHATMA GANDHI ROAD,MUMBAI
400001

Customer ID : 1H2890778

NEW INDIA TOP-UP MEDICLAIM POLICY SCHEDULE

UIN:NIAHLIP21276V022021

Insureds Details Issuing Office Details

Insured Name : MR. P.R. SREEKANTH Office Code : THE NEW INDIA ASSURANCE CO.
LTD., KANAKAPURA ROAD (670202)
Address : NO.512, 11TH MAIN BHCS LAYOUT Address : BRANCH (670202) NO.1A, SBI COLONY,
UTTARAHALLI MAIN ROAD (ABOVE BATA SHOW ROOM)
CHIKKALSANDRA POST BENGALURU 41ST MAIN, J.P.NAGAR 1ST PHASE,
SARAKKI GATE, KANAKAPURA
ROAD,,560078
BANGALORE ,KARNATAKA, 560061
Phone No/Mobile No. : XXXXXX7504 Phone No : 08022443967 / 08022443967 /
8022443967
E-mail Id : sreekanthpolepally72@gmail.com, / Fax No : 08022443967
: E-mail : nia.670202@newindia.co.in
PAN No : AJXPS7844N S.Tax Regn. No : AAACN4165CST178
GSTIN/UIN : NA / NA GSTIN : 29AAACN4165C2ZM
: SAC : 997133 (Accident and health insurance
services)

Policy Details
Business Source Code
Policy Number : 67020234227800000021 Dev.Off : DIRECT BUSINESS (1D7821762)
level./Broker/Direct/Web
Aggregator/CPSC User
Period of Insurance : From:10/06/2022 12:00:01 AM Agent/Bancassurance/Spe : Mr. KUMARA S (NIAAG00057913)
To:09/06/2023 11:59:59 PM cified Person
Previous Policy No. : 67020234217800000023 Phone No : 9483853173 / 08022443967,
Client Type : Non-Corporate E-mail/Fax : skumara572@gmail.com,
nia670202@newindia.co.in, / /
Policy Type : Floater

Member Details

Sl. No. Name of Insured Date of Birth Sex Occupation Relation Date of inception of Pre-existing
Person Continuous Disease
Coverage
1 MR. P.R. 25/08/1972 Male Business / Traders Self 10/06/2020 NA
SREEKANTH
2 P REKHA 21/08/1973 Female Professional / Adm Spouse 10/06/2020 NA
SREEKANTH inistrative / Mana
gerial

Sum Insured 2200000

Threshhold 800000

Member Details Of Previous policies

Sl. Name of Insured Person Expiring Policy No. Sum Insured Date of Inception of Threshold Pre-existing
No. first policy Disease
1 MR. P.R. SREEKANTH 67020234217800000023 2200000 10/06/2020 800000
2 P REKHA SREEKANTH 67020234217800000023 2200000 10/06/2020 800000

Signature Not
Verified
Digitally signed
by SRINIVASAN
VAIDESWARAN
Date: 2022.05.15 Policy No. : 67020234227800000021Document generated by QR_RENEWAL at 15/05/2022 21:20:08 Hours.
21:20:12 IST
Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Give your valuable feedback on https://www.newindia.co.in/portal/policyFeedbackGen.

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THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

Details Of TPA(Notice or communication to be given in respect of claims)

Name : MEDI ASSIST INSURANCE TPA PVT. Telephone : 18002089449
LTD.
Address : MEDI ASSIST INDIA TPA PVT. LTD., Fax : 18004259559
TOWER D, FOURTH FLOOR,,IBC Email :
KNOWLEDGE PARK, 4/1, Toll Free No. :
BANNERGHATTA ROAD,,BANGALORE Mobile No. : 8049698000
IBC KNOWLEDGE PARK, 4/1,
BANNERGHATTA ROAD,
BANGALORE

Name of Nominee : P REKHA SREEKANTH Relation : Spouse

Premium Working Table

Sl. No. Name of Insured Total Basic Premium Staff Discount Net Premium
1 MR. P.R. SREEKANTH 5600 0 5600
2 P REKHA SREEKANTH 2800 0 2800
Gross Premium 8400
GST 1512
Net Premium Amount 9912
Net Premium Amt.(In words) RUPEES NINE THOUSAND NINE
HUNDRED TWELVE ONLY

*This Policy is subject to terms and conditions of NEW INDIA TOP-UP MEDICLAIM POLICY.

Premium and GST Details

Rate of Tax Amount in INR
Premium 8400
SGST 9 756
CGST 9 756
IGST 0 0

IN WITNESS WHEREOF,the undersigned being duly authorized has hereunto set his/her hand

at this 10th day of June 2022

Date of Issue: 15/05/2022

(Mrs. K ADITYAVALLI)
[BRANCH MANAGER]
Authorized Signatory For and on behalf of
The New India Assurance Company Limited

Policy No. : 67020234227800000021Document generated by QR_RENEWAL at 15/05/2022 21:20:08 Hours.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Give your valuable feedback on https://www.newindia.co.in/portal/policyFeedbackGen.

Page 2 of 4
THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

Insurer Office Code : THE NEW INDIA ASSURANCE CO. LTD., KANAKAPURA ROAD (670202)
Address : BRANCH (670202) NO.1A, SBI COLONY, (ABOVE BATA SHOW ROOM)
41ST MAIN, J.P.NAGAR 1ST PHASE,
SARAKKI GATE, KANAKAPURA ROAD,,560078
Telephone : 08022443967 / 08022443967 / 8022443967
Fax : 08022443967

NEW INDIA TOP-UP MEDICLAIM

PREMIUM CERTIFICATE FOR THE PURPOSE OF DEDUCTION UNDER SECTION 80 D OF INCOME TAX ( AMENDMENT ) ACT 1986

This is to certify that Mr./Mrs. MR. P.R. SREEKANTH has paid ` RUPEES NINE THOUSAND NINE HUNDRED TWELVE ONLY (in
words) towards premium for NEW INDIA TOP-UP MEDICLAIM for the period 10/06/2022 12:00:01 AM to 09/06/2023 11:59:59
PM

Policy no. : 67020234227800000021

Receipt no. & date : 10000089220500233777
15/05/2022

Date of Issue: 15/05/2022

(Mrs. K ADITYAVALLI)
[BRANCH MANAGER]
Authorized Signatory For and on behalf of
The New India Assurance Company
Limited

(Note: This certificate must be surrendered to the Insurance Company for issuance of fresh certificate in case of cancellation
of the policy or any alteration in the Insurance affecting the premium)

Policy No. : 67020234227800000021Document generated by QR_RENEWAL at 15/05/2022 21:20:08 Hours.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Give your valuable feedback on https://www.newindia.co.in/portal/policyFeedbackGen.

Page 3 of 4
 THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

IMPORTANT

This policy is subject to the terms and conditions contained in the policy document (Clauses).

This policy is governed by Health Insurance Regulations 2016 issued by Insurance Regulatory
Development Authority of India on 12.07.2016.

This policy is also governed by IRDAI (Protection of Policyholders' Interest) Regulations, 2017.

This Schedule comes attached with the policy document (Clauses). If not attached, please ask for the
same.

Health Insurance Regulation 2016 and IRDAI (Protection of Policyholders' Interest) Regulations, 2017 are
available on the website of IRDAI.

Beware of spurious calls offering alluring benefits. Never share any policy details with unknown callers.
Call 1800-209-1415 for any enquiry or contact the nearest operating office of New India Assurance Co Ltd.

Tax Invoice No : 67020222P0000871

IRDA Registration Number: 190

NIA PAN NUMBER: AAACN4165C

Policy No. : 67020234227800000021Document generated by QR_RENEWAL at 15/05/2022 21:20:08 Hours.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Give your valuable feedback on https://www.newindia.co.in/portal/policyFeedbackGen.

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