Policy Issuing Office: Reliance General Insurance Co. Ltd.

, Policy Servicing Branch Office: Reliance General Insurance Co.

1st Floor, 9-1-125/3/1, Urban District, Sarojini Devi Road, Regimental Ltd,
Bazaar, Hyderabad, Telangana - 500003 Reliance General Insurance Co Ltd 202-21
2nd Floor MERCANTILE HOUSE
KASTURBA GANDHI MARG New Delhi New
Delhi 110001
Reliance Individual Mediclaim Policy Schedule

Name and Address of the Proposer: SYED IBRAHIM QUADRI

9-4-47/49/C ARBAZ PLAZA, NEAR PARAMOUNT COLONY
GATE 3, TOLICHOWKI, HYDERABAD
TELANAGANA – 500008
India
Mobile No: 6300737037
Policy Number 1301813831000291
Details of previous policy (in case of renewal)
Previous policy No. : NA

Date of expiry : NA
Sum Insured : As Indicated Below
Period of Insurance : From 00:01 on 25/05/2023 to mid-night on 24/05/2024

Name of Insured Gender Date of Relationship Occupation Pre-Existing Sum Domiciliary Amount Loading Premium
Person Birth with the Illness Insured Hospitalization of CB (%) (Rs)
Proposer (Rs) (Rs)
Limit (Rs)
SYED IBRAHIM QUADRI Male 26/02/1983 Self Others 50000.00 500000.00 555000.0 0 22,110.00
0

Where an Insured Person is added to this Policy, either by way of endorsement or at the time of renewal, the pre-existing disease clause, first year exclusion and 30
days waiting period is applicable considering such policy period as the first policy with us.
Policy would be considered as a fresh policy if there would be break of fifteen or more days between the previous policy expiry date and current policy start date.
Any enhanced Sum insured during subsequent policy renewals will not be available for an illness, diseases, injury already contracted under the preceding policy
periods. All Waiting periods as defined in the policy shall apply for this enhanced limit from the effective date of enhancement of such Sum Insured.
This Insurance is subject to the terms and conditions of policy attached. The policy wordings with detailed terms, conditions and exclusions are available on our
website www.reliancegeneral.co.in
Special Conditions, if any:

Premium Details Amount (Rs.)

Gross Premium 22,110.00
Service Tax (12% of Net Premium) 2173.20

Education Cess (2% of Service Tax) 43.46

Secondary and Higher Education Cess (1% of Service Tax) 21.73
Total Premium 25,348.00

(Service Tax Registration No: AABCR6747BST001)

Consolidated Stamp duty Paid vide Receipt No.20984 dated 25/05/2023
** ** Not applicable for the State of Jammu and Kashmir
Note: In the event of dishonor of cheque, this policy document automatically stands cancelled from inception, irrespective of whether a separate communication is
sent or not. In witness whereof this policy has been signed at Hyderabad on 25/05/2023
For any assistance with claims, please contact us on 1 800 3002 8282 (toll free) and 3989 8282 (local charges apply) or email us at services.rgicl@relianceada.com
 TPA/Service Provider Details

TPA/Service Provider Name Paramount Health Services Pvt. Ltd.

Address, Please Log on to www.paramounttpa.com for locating the nearest office for submission of claim documents

24X7 Customer Helpline Number 022-66620880/ (022) 6662 0880(Toll-free)

Fax Number (022) 2825 9543 /9743
Email id contact.phs@paramounttpa.com (For Insured Grievance
& for any other queries)

Premium Certificate
Premium Certificate for the purpose of deduction under Section 80-(D) of Income Tax (Amendment) Act 1986.
This is to certify that SYED IBRAHIM QUADRI has paid Rs .25348 (TWENTY FIVE THOUSAND THREE HUNDRED FOURTY EIGHT) towards premium for Health
Insurance for the
Period From 00:01 on 25/05/2023 to Midnight of 24/05/2024 on May 25, 2023
Policy Number: 1301813831000291
Date: 25/05/2023 Place: Hyderabad
Note: This certificate must be surrendered to the Insurance Company for issuance of fresh certificate in case of cancellation of policy or any alteration in the
insurance affecting the premium.
Registered Office: 1st Floor, 9-1-125/3/1, Urban District, Sarojini Devi Road, Regimental Bazaar, Hyderabad, Telangana - 500003