Draft letter to be obtained for inclusion of New Born Baby

From

MOHAMED RAFEEK MOHAMED ILYAS

2/122, AMBALAKAR STREET
PERUMAL PALAYAM
THURAIYUR, TRICHY - 621008

To
Star Health and Allied Insurance Co. Ltd.,

Dear Sir/Madam,

Reg : Inclusion of new born baby under policy no: _P/700002/01/2023/058430 Customer ID 8231458-1
I request you to kindly include new born baby under the policy no.___ P/700002/01/2023/058430 ____________________

Details of new born baby as follows :-

Name of the new born : AADHILA

Gender : FEMALE
Date of Birth : 28/08/2023
Place of Birth : THURAIYUR
Name of the hospital : NIMAL NURSING HOME, THURAIYUR
The health history of the new born baby as follows :-

1.Complications following birth (Yes/No) No complications, Birth was by C-section for the reason that uterus
(If yes, please furnish details) mouth was not fully opened.

2. Intensive care treatment required at birth / No

immediately after birth (Yes/No)
(If yes, please furnish details)
3.Any medical illnesses suffered (Yes/No) No
(If yes, please furnish details)

4. Congenital illness / conditions identified, if

No
any, whether internal or external
5. Maternity cover has undergone with our
No
star health insurance.(Yes/No)

I hereby declare that above said new born baby is currently healthy and does not suffer from any illness and/or health
condition(s).

I further declare that the above particulars given by me are true and complete in all respects, to the best of my knowledge and
belief, and that I am authorized to propose for insurance coverage of the new born baby. I declare and consent to the company
seeking medical information from any doctor or from a hospital who at anytime has attended on the new born baby. I authorize
the company to share information pertaining to the new born baby, the medical records for the sole purpose of proposal
underwriting and/or claims settlement and with any Government and/or Regulatory authority.

I understand that this new born baby will be covered under the current policy, subject to your approval, without additional
premium, and it will continue to be covered under the subsequent renewal policy, on payment of appropriate premium.

Signature : MOHAMED RAFEEK MOHAMED ILYAS

Place: THURAIYUR
Date: 08/10/2023