HDFC ERGO General Insurance Company Limited

Fa

2952200983197100000
0
Date : 06/08/2023
Dear K.SIVACHANDRAN,
NO 12A, BAJANAI KOVIL STREET,
MINJUR, CHENNAI, TAMIL NADU, 601203.
Contact No. 9840577881

We thank you for trusting HDFC ERGO General Insurance. Enclosed herewith is your insurance policy which has been confirmed on
the basis of the information and declaration given by you.

Product Name Policy No. Sum Insured (`) Premium (`)

Health Suraksha Policy 2952200983197100000/1 500,000.00 55,626.00

Sarv Suraksha Policy-Personal Accident 2952200983197100000/2 1,000,000.00 1,888.00
The insurance policy enclosed herewith represents a written agreement confirming the terms of the cover agreed as per our telephonic
conversation with you.

To ensure seamless & hassle-free services, we request you to kindly check your contact and other details on your policy schedule on the
basis of which the insurance is issued. In case of any discrepancy please call our toll free 1800 2 700 700.

For any further assistance on your policy or to know more about our other products, please free to contact us. We once again thank you
for choosing HDFC ERGO and heartily welcome you to our growing family.

For HDFC ERGO General Insurance Company Ltd.

Karan Chopra
Head - Retail Business Group

HDFC ERGO General Insurance Company Limited 2952200972197100000/1

Dear K.Sivachandran,
Subject : Certificate for the purpose of deduction under section 80 D of Income Tax (Amendment) Act, 1986*
This is to certify that we have received an amount of ` 55,626.00 (RUPEES FIFTY FIVE THOUSAND SIX
HUNDRED TWENTY-SIX AND ZERO PAISE Only) towards premium for Health Suraksha Policy, Policy
No. 2952200983197100000/1 issued to Sivachandran for the period 06/08/2023 to 05/08/2024.

Note:

1. This is subject to the provisions of Section 80D of income tax (Amendment) Act, 1986 as amended from time to time.
2. This certificate must be surrendered to the company in case of cancellation of this policy. In event of incorrect representation of this
declaration the liability shall be upon the policy holder.
Date : 06/08/2023
For HDFC ERGO General Insurance Company Ltd.
Policy Issuing Office: Mumbai

Duly Constituted Attorney

Registered & Corporate Office: 1st Floor, 165-166 Backbay Reclamation, H. T . Parekh Marg, Churchgate, Mumbai - 400020. Customer Service Address: 6th Floor, Leela Business Park, Andheri Kurla Road,
Andheri (E), Mumbai - 400 059. Toll Free : 1800-2-700-700 (Accessible from India only) | Fax : 91 22 6638 3699 | care@hdfcergo.com | www.hdfcergo.com