HEALTH INSURANCE POLICY - SCHEDULE

Policy No. : P/700019095/00756/0 Previous Policy No. :

Proposer's Code : 3629870 Issuing Office Code : 03148119
Proposer's Name : KHUDOYBERDIEV SIRODJ Issuing Office Name : Online Business
Address : Address :
UZBEKISTAN 20 Gracechurch Street,
London,
United Kingdom,
EC3V 0BG
Phone No: +998979229322 Toll Free No : 0800 111 4004
E-mail id : tolibovsadriddin1961@gmail.com E-mail id : info@axahealth.co.uk
Proposal date : 14.02.2024 Fulfiller Code : SO700002 Sector : Urban
Date of Inception of first policy : 08.03.2024
Renewal Year : NEW
Receipt No : 1272007867
Receipt Date : 14.02.2024
Service Tax : 180.00 USD

PERIOD OF INSURANCE FROM : 08.03.2024 00:00:00 TO : Midnight Of 08.09.2024

SCHEME - DESCRIPTION : 1 ADULT
BASIC FLOATER SUM INSURED : 32000 GBP
LIMIT OF COVERAGE : 32000 GBP
.
Details of Insured Person:

Name of the Insured Sex Date of Birth Relationship with Proposer Pre Existing Disease/s ID Card No

KHUDOYBERDIEV SIRODJ MALE 13.02.1990 SELF NONE 3629870

Warranted that in case of dishonor of premium cheque(s), the Company shall not be liable under the policy and the policy shall be void abinitio (from inception).

THE INSURANCE UNDER THIS POLICY IS SUBJECT TO CONDITIONS, CLAUSES, WARRANTIES, EXCLUSIONS ETC., ATTACHED. IMPORTANT
IN THE EVENT OF HOSPITALIZATION OF INSURED PERSON, INTIMATION SHOULD BE GIVEN TO THE COMPANY IMMEDIATELY,
HOWEVER, WITHIN 24 HRS FROM THE TIME OF ADMISSION.

In the event of the policy being withdrawn in future, intimation about the withdrawal will be sent 3 months prior to the date when renewal falls due. The insured will have the option of migrating to any other
similar health insurance policy offered by the Company at the relevant time.
Continuity of benefits for waiting period and bonus, if any and if applicable, will be given provided the insured had been renewing the policy without any break (or renewing within the grace period
offered)

Entered By: This is an electronically No.CSD/1646/2177 Authorised

STAR_PORTAL generated document (Policy Dt.14.02.2024 Signatory
Schedule). Consolidated stamp
IRDA Regn. No 129 paid vide certificate
Corporate Identity Number U66010TN2005PLC056649

Email ID : info@axahealth.co.uk

Kannan S
CN=Kannan S,
SERIALNUMBER=f29a5b3b9c6f48e2841a06abb56c43b5ab5
647325765c9667cc1b11bd05622a2, ST=Tamil Nadu, OID.
2.5.4.17=600034, OU=Star Health And Allied Insurance Company
Limited, O=Star Health And Allied Insurance Company Limited, C=IN