29-Jun-2023

Mr Md Anish Ahmed
Sajjad Nagar Agency Code 80095655
Apna Gharana Agency Name BHAWNA GOEL
Phulwarisharif
Agency Contact No 9313153874
801505
Bihar
India
Contact No.: 8809488987
Policy No: 110101/11119/6000112372-01

Renewal of Your Optima Restore Insurance Policy

Dear Mr Md Anish Ahmed,

Thank You for renewing the policy with us.

We are pleased to enclose your renewed Policy Kit for the period 23-Jul-2023 to 22-Jul-2024. The Kit contains:

1. The Policy Schedule along with income tax (80 D) certificate (wherever applicable)
2. Member cashless card/s
3. Important Information related to Claim Procedure, and
4. Let's Stay Healthy - Value adds from Apollo Munich

To know more about policy related information and value added offers, you may re-register yourself at our website using
your unique member ID and policy number as mentioned in the policy schedule.

In case of any query, please feel free to write to customerservice@apollomunichinsurance.com or call us at our 24 hours
toll free number 1800-102-0333. Our customer care team will be happy to assist you.

Warm Regards,

Authorized Signatory

Note:-
- Revision in Policy wordings (if any) due to regulatory compliance or any other reason can be accessed through our
website www.apollomunichinsurance.com.
- Please update us with your latest contact details (in case of any change) so that same can be updated in our records.
You can either write back to us or call us on our toll free no. 18001020333.
 OPTIMA RESTORE POLICY SCHEDULE - Optima Restore Individual

Issuing Office: Pitampura Sales Office

Mr Md Anish Ahmed
Policy Holder's Name:

Policy Holder's Address: Sajjad Nagar Apna Gharana

Phulwarisharif - 801505
Bihar
India
Agency Code: 80095655
Agency Name: BHAWNA GOEL
Agency Contact No: 9313153874
Policy Number: 10101/11119/6000112372-01
First policy inception date: 23-Jul-2019
Policy Period: From 00.00 hrs on 23-Jul-2022 To 24.00 hrs on 22-Jul-2024
Insured Persons Details:

Member ID Insured Person's Name Relationship to Policyholder Basic Sum Insured (Rs.) Multiplier Benefit (Rs)

10005815857 Mr Md Anish Ahmed Policy Holder 2500000 1250000

Nominee Name: Mrs Sufra Alia Shaz Relationship: Wife

The nominee must be an immediate relative of the policyholder. For all other Insured Persons the policy holder shall be the
nominee
Premium Calculation:
Net Premium (Rs) 23609.00
Discounts (Rs) 0.00
Loadings (Rs) 0.00

Service Tax (Rs) 2673.08

Duties and cess as applicable (Rs) 120.19

Gross Premium (Rs) 26402.27

Gross premium amount (in words) Rupees Twenty Six Thousand Four Hundred Two and Twenty-
Seven Paisa Only

The stamp duty of Rs. 0.50/- (Paisa Fifty Only) paid vide No.F.10(783)/COS(HQ)/Con.duty/08. (Not applicable for the state of
Jammu & Kashmir).
Service Tax Registration No.: AAGCA1654HST002
EXCLUSION(S) / SPECIAL CONDITION(S):
Member ID No of Insured Person Name Details
10005815857 Mr Md Anish Ahmed For Rs 500000 (Rupees Five Lakh) Sum Insured - Sec 4B)
of the policy wording is waived, Sec 4C) is reduced to 1
year and Sec4D) is reduced to 2 years.

Claim Administrator: Apollo Munich For and on behalf of Apollo Munich Health Insurance Company Limited

Location: Gurgaon
Date: 29-Jun-2023 Authorized Signatory
 Certificate for the purpose of deduction under Section 80 D of Income Tax (Amendment) Act, 1986*

This is to certify that MR Md Anish Ahmed has paid Rs 26402.27 (Rupees Twenty Six Thousand Four Hundred Two and
Twenty- Seven Paisa Only) towards premium for Optima Restore Individual Policy No 110101/11119/6000112372-01
issued to Mr Md Anish Ahmed for period 23-Jul-2023 to 22-Jul-2024.

For and on behalf of Apollo Munich Health Insurance Company

Limited

Location: Gurgaon
Date: 29-Jun-2022 Authorized Signatory

* 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.
3. Please note that this certificate will not be issued if the premium payment has been made in cash.