Welcome To Bajaj Allianz Family: Insured Name Policy Number Vikas Ganesh Shinde 12-8450-0000030389-04

Welcome to Bajaj Allianz Family
Policy issuing office and Correspondence address for communication AURUNGABAD-Abc East,,3rd Floor,,Chilkathana Midc,,
by policyholder for claim, service request, notice, summons, etc. Aurangabad,Maharashtra,431210,INDIA
Insured Name Vikas Ganesh Shinde Policy number 12-8450-0000030389-04
Name: Vikas Ganesh Shinde

Address:
Line1: S/O Ganesh Shinde, 3 June Gaon Thanat Satgaon Null Null Null Null
Line2:
City: Buldhana State: 27 - MAHARASHTRA
Post Code: 443106
Mobile Number: 9969722355
Customer ID: 130768949
Dear Vikas Ganesh Shinde,
It is our privilege to welcome you to the Bajaj Allianz General Insurance family.
We thank you for choosing Bajaj Allianz for your Insurance needs. We are one of India's leading general insurance companies with iAAA
rating from ICRA for the last ten consecutive years indicating the company's high claims paying ability and fundamentally strong
position in the industry. Please be assured that you have made right choice by choosing us and we will stand by you in your hour of
need.
Please find enclosed the policy schedule. We wish to inform you that the policy issued is based on the information submitted in the
proposal form as well as the acceptance of the terms and conditions, and this will be verified at the time of filing of claim. Request you
to kindly go through the same once again and in case of any disagreement, discrepancy or clarifications – write to us at
bagichelp@bajajallianz.co.in within 15 days of the letter date.For policy wordings containing detailed terms, conditions and exclusions
of your insurance coverage follow below link
https://www.bajajallianz.com/download-documents/health-insurance/health-guard/Health-Guard-Policy-Wordings-print.pdf
Once again, we welcome you to the Bajaj Allianz family and look forward to a long association with you.
We assure you the best of our services and look forward to a continual patronage and association with you.
For & on the behalf

Bajaj Allianz General Insurance Company Ltd.
Authorized Signatory
Signature Not Verified

Digitally signed by DS BAJAJ ALLIANZ GENERAL
INSURANCE COMPANY LIMITED 01
Date: 2022.10.24 07:28:29 IST
Bajaj Allianz General Insurance Co. Bajaj Allianz House,Airport Road,Yerwada,Pune - 411 006. Reg. No.: 113 CIN: U66010PN2000PLC015329
Give a Missed Call on 808094506 SMS 'WORRY' to 575758 http://www.facebook.com/BajajAllianz
Contact our 24-Hour Call Center at 1800-209-5858 http://twitter.com/BajajAllianz
www.bajajallianz.com http://www.linkedin.com/company/bajaj-allianz-general-insurance
bagichelp@bajajallianz.co.in Demystify Insurance https://www.bajajallianz.com/blog.html

HEALTH GUARD - INDIVIDUAL- POLICY SCHEDULE
UIN : BAJHLIP23065V052223
Policy issuing office and Correspondence address for communication AURUNGABAD-Abc East,,3rd Floor,,Chilkathana Midc,,Aurangabad,
by policyholder for claim, service request, notice, summons, etc. Maharashtra,431210,INDIA
Proposer Details
Proposer Name Vikas Ganesh Shinde
S/O GANESH SHINDE, 3 JUNE GAON THANAT SATGAON null null null null, BULDHANA, MAHARASHTRA, 443106,
Proposer Address
INDIA
Phone No 9969722355 Email ID drvickyshinde@gmail.com
Customer ID 130768949
Previous Policy No 12-8450-0000030389-03 Previous Policy Expiry Date 18/11/2022
Policy Details
Policy Number 12-8450-0000030389-04 Endorsement No NA
Policy Issued on 24/10/2022 Policy Status ACTIVE
From 19/11/2022 00:00 Hrs To 18/11/2023

Period of Insurance Expiry Date 18/11/2023
Midnight
GSTIN / UIN Unregistered Place of Supply/State

Code/Name 27 - MAHARASHTRA
Company GST No: 27AABCB5730G1ZX
Company PAN AABCB5730G Invoice No: 272210I001006991
Insured Member Details

Nominee Name First Policy
Member Name Customer ID Plan Gender Date of Birth Age Relation
& Relation Inception Date
Vikas Ganesh 1. Kokila Ashok
130768949 Gold Male 27/02/1987 35.0 Self
Gaikwad - 19/11/2018
Shinde
Spouse
Kokila Ashok 1. Vikas
130777261 Gold Female 09/12/1992 29.0 Spouse Ganesh Shinde 19/11/2018
Gaikwad
- Spouse
Radhabai Ganesh 1. Vikas
130777262 Gold Female 15/06/1961 61.0 Mother Ganesh Shinde 19/11/2018
Shinde
- Son
S/O GANESH SHINDE, 3 JUNE GAON THANAT SATGAON null null null null, BULDHANA, MAHARASHTRA,
Insured address
443106, INDIA
Sum Insured & Cover Details

Daily Cash for Preventive
Inpatient Hospitalisation Treatment Convalesce Reinstateme Maternity Recharge
Member Name Accompanying Health
nce Benefit nt Benefit Expenses Benefit Limit
an Insured Check Up
Sum Sum
CB(CB%) SCB Sum Insured Sum Insured Sum Insured Sum Insured Sum Insured
Insured Insured
Vikas Ganesh 60000
300000 NA 5000 0 300000 0 3000 0
Shinde (20%)
Kokila Ashok 120000
300000 NA 5000 0 300000 25000 3000 0
Gaikwad (40%)
Radhabai Ganesh 120000
300000 NA 5000 0 300000 25000 3000 0
Shinde (40%)
Add on Cover
Waiver of Room Capping Non-Medical Expenses Cover Health Prime Rider
Member Name
UIN: BAJHLA21577V012021 UIN: BAJHLAP21586V012021 UIN: BAJHLIA22169V012122

Member Name
Individual Option 5
VIKAS GANESH SHINDE No No Telconsultation:- Unlimited
(All Specialities),
Investigations Cover:- 7000,
Doctor consultaion:- 3000,
Annual preventive health
check-up:- Yes (1 Voucher)
Individual Option 5
KOKILA ASHOK GAIKWAD No No Telconsultation:- Unlimited
(All Specialities),
Individual Option 5
RADHABAI GANESH SHINDE No No Telconsultation:- Unlimited
(All Specialities),
Premium Details
Description Amount(INR) Description Amount(INR)
Zone B / Zone C Discount 0
Base Premium 52250
Family Discount 7837
Premium Payment Zone Zone A Long Term Policy Discount 0
Voluntary Co-payment Opted-10%/20% 0 Voluntary Co-payment Discount@10%/20% 0
Premium on Add-on Cover 0 Room Rent Capping Discount 0

Employee Discount 0
Premium on Health Prime Rider 2550
Online Discount/Direct Customer Discount 0
Discount on Health Prime Rider 381
Wellness Discount 0
Gross Premium: Fifty-Two Thousand Four Hundred Nine
Rupees Total Discount 7837
Eligible Discount 7455
Net Premium 44415
State GST(9%) 3997
Central GST(9%) 3997
IGST 0
UTGST 0
CESS 0
Gross Premium 52409
"As per the GST regulations, the amount of GST will not be refunded if the policy / endorsement is cancelled after 30th September of the next
financial year E. & O.E"
"In case no GSTIN or incorrect GSTIN is provided by the Proposer at Proposal stage, Bajaj Allianz General Insurance Company Ltd shall not be
responsible for any Input Tax Credit losses and no subsequent revision of invoice will be undertaken."
Exclusions
Member Name Exclusion
Vikas Ganesh Shinde NA
Kokila Ashok Gaikwad NA

It is hereby agreed and understood that this Policy Excludes For RADHABAI GANESH SHINDE any claims in
respect of any disorder, injury, disease, disability or treatment directly caused by or attributable to
Radhabai Ganesh Hypertension, Cardiovascular diseases, Cerebrovascular diseases,Thyroid disorders its complications & related
Shinde disorders/any other ailment existing on or before the commencement date. The above exclusion shall cease to
apply from 4th year, if you have maintained a Health Guard Policy with us for a continuous period of a full 3
years without break from the date of your first Health Guard Policy with Us.
Special Exclusion at Policy

NA
Level
Additional Remarks NA
This is to certify that Vikas Ganesh Shinde has paid Rs.52409 towards Health Insurance premium for
Period and Policy Number as mentioned on the Policy Schedule and is eligible for Deduction under
Section 80-D of Income Tax (Amendment) Act, 1986
Notes:
80D Certificate 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.
3. In event of incorrect representation of this declaration the liability shall be upon the policy holder.
4. This certificate will not be valid if premium payment has been made in cash.
Receipt Number: 54-22-000000736749 Date: 24/10/2022 Premium Payer ID: 130768949 Float: NA;
Premium Payment Details Payment Frequency: Single Premium ** If Premium paid through Cheque, the Policy is void ab-initio in
case of dishonour of Cheque
Financial Institution Ref. No. NA
AGENCY CODE 10028075 CONTACT NO 09970053177

AGENCY NAME Sharadpundalikamrutkar Pundalik EMAIL ID SHARADAMRITKAR@GMAIL.COM
For & on the behalf

Bajaj Allianz General Insurance Company Ltd. Consolidated Stamp Duty of Rs. 0.25/- paid towards Insurance Premium Stamps Vide
Challan No MH002405964202122M defaced number 0001482221202122/order no.
CSD/82/2021/2306 dated 12-APR-21 timing 13:29:05 of General Stamp of India.
Stamp Duty
Rs.0.25/- This document is digitally signed,hence counter signature / stamp is not required
Principal Location : Bajaj Allianz House,Airport Road,Yerwada,Pune- 411006 PH-
66026666 | Services Accounting Code : 997133 Accident and health insurance services.
Authorized Signatory No reverse charge is payable on these services.
SUB 10028075 / NA
Policy Verification Claim Registration
Our Insurance Expert will call you for hassle free renewal and industry best offers on your coverage
Bajaj Allianz General Insurance Co.Ltd. Bajaj Allianz House,Airport Road,Yerwada,Pune - 411006. Reg.No.:113 CIN:U66010PN2000PLC015329
Give a Missed Call on 8080945060, SMS 'WORRY' to 575758 http://www.facebook.com/BajajAllianz

RECEIPT
Policy issuing office and Correspondence address for communication AURUNGABAD-Abc East,,3rd Floor,,Chilkathana Midc,,
by policyholder for claim, service request, notice, summons, etc. Aurangabad,Maharashtra,431210,INDIA
Proposer Name Vikas Ganesh Shinde Policy Number 12-8450-0000030389-04
Receipt Number 54-22-000000736749 Receipt Date 24/10/2022
Business Channel CY
Received with thanks from: Vikas Ganesh Shinde
Customer ID: 130768949 a total sum of Rupees Fifty-Two Thousand Four Hundred Nine Rupees Only by,
Instrument Type Instrument No Instrument Date Bank Name Branch Name Amount (Rs.)
Online Payment 95623172 24-Oct-2022 BN00000146 BN00000146 52,409.00
Total Amount: 52409
Note: Issuance of this receipt does not amount of acceptance of the risk by Bajaj Allianz General Insurance Company Limited. The insurance cover for
the risk shall be as per the terms and conditions of the Insurance Policy if and when issued.
*Cheque/DD/PO receipt is valid subject to realisation of the instrument
For & on the behalf


Transcript of Proposal for ([11-8450-0000030389-04] HEALTH
GUARD - INDIVIDUAL)
Dear Vikas Ganesh Shinde,
We wish to inform you that your contract will be based on the information and declaration given by you through telephonic conversation / email / web-
inputs / TAB /CSC Centers or other means which would be considered as the final proposal, the transcript of which is as follows:
You are requested to yourself reconfirm the same at your end. In case of any disagreement or objection or any changes with respect to information
mentioned below, we request you to please revert within a period of 15 days from the date of your receipt of this document. In case of our non-receipt
of your disagreement or objection or any changes [as mentioned hereinabove] with respect to information mentioned below, it shall be deemed that
you have positively confirmed to us the correctness of the below mentioned transcript and declaration. Where you disagree to any of
information/contents of this transcript, standard Terms or conditions, you have the option to return the original Policy stating the reasons for your
objection, and upon our receipt of original Policy together with your request to cancel the Policy, you shall be entitled to a refund of the premium paid,
subject only to there being no claim made under the Policy and also subject to a deduction of the expenses incurred by us and the stamp duty
charges.
Proposer Details
Proposer Name Vikas Ganesh Shinde
Are you an Existing Bajaj Allianz Customer: Yes/No If Yes, please mention the policy No
Gender Male Date of Birth 27/02/1987
PAN No ERLPS4409H UID/Unique ID NA
Bajaj Allianz Employee Code, if Proposer is BAGIC/BALIC Employee NA
Marital Status Married No of children NA
Occupation Others
Address
Permanent/ Residential Address Correspondence Address
(All the communications will be sent to the below address)
S/O Ganesh Shinde, 3 June Gaon Thanat S/O Ganesh Shinde, 3 June Gaon Thanat
Address Line 1 Address Line 1
Satgaon Null Null Null Null Satgaon Null Null Null Null
Address Line 2 NA Address Line 2 NA
Address Line 3 NA Address Line 3 Mhasla Bk
City/District Buldhana City/District Buldhana
State Maharashtra State Maharashtra
Pin Code 443106 Pin Code 443106
Telephone 9969722355 Telephone 9969722355
Mobile 9969722355 Mobile 9969722355
Email drvickyshinde@gmail.com Email drvickyshinde@gmail.com
Educational Qualification NA
Family Monthly Income 0
In case of any offer, you would prefer to be contacted by 9969722355,drvickyshinde@gmail.com
Nationality Indian
Policy Period 1 Year
Plan Individual
Sum Insured Options
a) Health Guard Individual Sum insured 300000
b) Health Guard Family Floater Sum Insured NA

GUARD - INDIVIDUAL)
Premium Payment Zone:
There are three Zones for Premium Payment-
Zone A
Delhi/NCR, Mumbai including (Navi Mumbai, Thane and Kalyan), Hyderabad and Secunderabad, Kolkata, Ahmedabad, Vadodara and
No Co-Payment
Zone B
Rest of India apart from Zone A & Zone C
* 15% Co-Payment Applicable if treatment availed in Zone A locations
Zone C
Goa, Chhattisgarh, Punjab, Chandigarh, Jammu & Kashmir, Jharkhand, Arunachal Pradesh, Bihar, Himachal Pradesh, Nagaland, Odisha,
Sikkim, Tripura, Uttarakhand, Manipur, Meghalaya, Mizoram, Andaman & Nicobar islands
*20% & 5% Co-Payment Applicable if treatment availed in Zone A and Zone B locations respectively
Note:-
Policyholder residing in Zone B and Zone C can choose to pay premium of Zone A and avail treatment all over India without any
co-payment.
Policyholders paying Zone A premium rates can avail treatment allover India without any co-payment.
But, those, who pay zone B premium rates and avail treatment in zone A city will have to pay 15% co-payment on admissible claim
amount.This Co - payment will not be applicable for Accidental Hospitalization cases."
Policyholder residing in Zone B can choose to pay premium for zone A and avail treatment all over India without any co-payment.
Co pay Discount:
Note:If opted voluntarily by the Insured then Insured will be eligible of additional 10% or 20% discount respectively on the policy
premium.In case of a claim has been admitted under In-Patient Hospitalization Treatment then, the insured person shall bear 10% or
20% respectively of the eligible claim amount payable under this cover.
Details of the Persons to be Insured

Relationship Date of Nominee
Gender Sum
Member Details with Birth Age Height Weight Nominee Relationship
(M/F) Insured
Proposer (DD/MM/Y with Insured
1. Kokila
27/02/198
Vikas Ganesh Shinde Self 35.0 - - Male 300000 Ashok 1. Spouse
7
Gaikwad
1. Vikas
09/12/199
Kokila Ashok Gaikwad Spouse 29.0 - - Female 300000 Ganesh 1. Spouse
2
Shinde
1. Vikas
15/06/196
Radhabai Ganesh Shinde Mother 61.0 - - Female 300000 Ganesh 1. Son
1
Shinde
Add On Cover
Member Name
Individual Option 5
VIKAS GANESH SHINDE No No Telconsultation:- Unlimited
(All Specialities),
Individual Option 5
KOKILA ASHOK GAIKWAD No No Telconsultation:- Unlimited
(All Specialities),
Individual Option 5
RADHABAI GANESH SHINDE No No Telconsultation:- Unlimited
(All Specialities),
Member Name Health Questionnaire Yes/No Details

GUARD - INDIVIDUAL)
Vikas Ganesh Shinde Has any of the persons to be insured suffer from/or No NA
investigated for any of the following?Disorder of the heart,
or circulatory system, chest pain, high blood pressure,
stroke, asthma any respiratory conditions, cancer tumor
lump of any kind, diabetes, hepatitis, disorder of urinary
tract or kidneys, blood disorder, any mental or psychiatric
conditions, any disease of brain or nervous system, fits
(epilepsy) slipped disc, backache, any congenital/ birth
defects/ urinary diseases, AIDS or positive HIV, If yes,
indicate in the table given below.If yes please provide
details
Vikas Ganesh Shinde Do you or any of the family members to be covered No NA
have/had any health complaints/met with any accident in
the past 4 years and prior to 4 years and have been taking
treatment, regular medication (self/ prescribed)or planned
for any treatment / surgery / hospitalization?
Vikas Ganesh Shinde Do you smoke cigarettes or consume tobacco (chewing No NA
paste) / alcohol, nicotine or marijuana in any form? Please
give duration and daily consumption
Vikas Ganesh Shinde Have you or any of your immediate family members (father, No NA
mother, brother, or sister) have/had cancer, heart attack, or
stroke and at what age? Prior to age 60?
Vikas Ganesh Shinde Has any proposal for life, critical illness or health related No NA
insurance on your life or lives ever been postponed,
declined or accepted on special terms? If yes, give details
Vikas Ganesh Shinde Are you vaccinated against Covid 19? (If yes, Give NA NA
Vaccination Details.)
Vikas Ganesh Shinde Have you or any of the persons proposed to be insured NA NA
were/are detected as Covid positive (If Yes, Give Date of
Detection and Treatment Details.)
Kokila Ashok Gaikwad Has any of the persons to be insured suffer from/or No NA
investigated for any of the following?Disorder of the heart,
details
Kokila Ashok Gaikwad Do you or any of the family members to be covered No NA
have/had any health complaints/met with any accident in
Kokila Ashok Gaikwad Do you smoke cigarettes or consume tobacco (chewing No NA
paste) / alcohol, nicotine or marijuana in any form? Please
Kokila Ashok Gaikwad Have you or any of your immediate family members (father, No NA
mother, brother, or sister) have/had cancer, heart attack, or
Kokila Ashok Gaikwad Has any proposal for life, critical illness or health related No NA
insurance on your life or lives ever been postponed,
Kokila Ashok Gaikwad Are you vaccinated against Covid 19? (If yes, Give NA NA
Vaccination Details.)
Kokila Ashok Gaikwad Have you or any of the persons proposed to be insured NA NA
were/are detected as Covid positive (If Yes, Give Date of
Radhabai Ganesh Has any of the persons to be insured suffer from/or No NA
Shinde investigated for any of the following?Disorder of the heart,
details
GUARD - INDIVIDUAL)
Radhabai Ganesh Do you or any of the family members to be covered No NA

Shinde have/had any health complaints/met with any accident in
Radhabai Ganesh Do you smoke cigarettes or consume tobacco (chewing No NA
Shinde paste) / alcohol, nicotine or marijuana in any form? Please
Radhabai Ganesh Have you or any of your immediate family members (father, No NA
Shinde mother, brother, or sister) have/had cancer, heart attack, or
Radhabai Ganesh Has any proposal for life, critical illness or health related No NA
Shinde insurance on your life or lives ever been postponed,
Radhabai Ganesh Are you vaccinated against Covid 19? (If yes, Give NA NA
Shinde Vaccination Details.)
Radhabai Ganesh Have you or any of the persons proposed to be insured NA NA
Shinde were/are detected as Covid positive (If Yes, Give Date of
Kindly note that as the information/contents and declarations/confirmations provided by you as contained in this transcript is the basis on which we are
issuing / have issued the Policy to you, we advise you to please ensure that you have provided/disclosed and or not withheld any material
facts/information and declarations, as Policy becomes Void ab-initio if material facts are not provided/disclosed and or withheld and in such case no
claim, if any, will be considered by us apart from forfeiture of the premium.
Disclaimer
A. EXCLUSIONS AND TERMS AND CONDITIONS:
The detailed list of exclusions, standard terms and conditions, including the exclusion of pre-existing ailments/diseases, were fully explained to you and
for full details thereof please refer to the Policy wordings:
Answer given by You: Yes, I/we have been explained in full the details of exclusions, standard terms and conditions including the exclusion of pre-
existing ailments/diseases and knowing the same I/we have opted and proposed for this Policy.
B. The contents of the proposal [transcript of proposal of you is this document] and connected documents have been fully explained to him and you
have fully understood the significance of the proposed contract basis which you have confirmed for policy issuance.
C. In case of Disagreement or objection or any changes with respect to information, declarations, Terms and Conditions, exclusions and contents
mentioned hereinabove, please contact our toll free number & register your objections / changes / disagreement to the contents of this transcript or you
may also send us email or written correspondence at the following details within a period of 15 days from date of your receipt of this transcript along
with Policy.
Declaration
1. I hereby declare, on my behalf and on behalf of all persons proposed to be insured, that the above statements, answers and/or particulars given by
me are true and complete in all respects to the best of my knowledge and that I am authorised to propose on behalf of these other persons.
2. I understand that the information provided by me will form the basis of the insurance policy, is subject to the Board approved underwriting policy of
the insurer and that the policy will come into force only after full payment of the premium chargeable.
3. I further declare that I will notify in writing any change occurring in the occupation or general health of the life to be insured/proposer after the
proposal has been submitted but before communication of the risk acceptance by the company.
4. I declare that I consent to the company seeking medical information from any doctor or hospital who/which at any time has attended on the person
to be insured/proposer or from any past or present employer concerning anything which affects the physical or mental health of the person to be
insured/proposer and seeking information from any insurer to whom an application for insurance on the person to be insured /proposer has been made
for the purpose of underwriting the proposal and/or claim settlement.
5. I authorize the company to share information pertaining to my proposal including the medical records of the insured/proposer for the sole purpose of
underwriting the proposal and/or claims settlement and with any Governmental and/or Regulatory authority.
Prohibition of Rebates
SECTION 41 OF INSURANCE ACT, 1938
GUARD - INDIVIDUAL)
No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take out or renew or continue an insurance in
respect of any kind of risk relating to lives or property in India, any rebate of the whole or part of the commission payable or any rebate of the premium
shown on the policy, nor shall any person taking out or renewing or continuing a policy accept any rebate except such rebate as may be allowed in
accordance with the published prospectuses or tables of the Insurer. Any person making default in complying with the provisions of this section shall
be punishable with a penalty, which may extend to Ten Lakh Rupees.
This transcript is authorized by you through OTP from your registered mobile no 9969722355 on
Contact our Policy servicing branch at: AURUNGABAD-Abc East,,3rd Floor,,Chilkathana Midc,,Aurangabad,Maharashtra,INDIA,431210
** This is print of electronic records maintained by us in accordance with law and hence does not require signature.
Contact our 24-Hour Call Center at 1800-209- http://twitter.com/BajajAllianz

HEALTH & WELLNESS CARD
Scan QR to view your policy details

Health Card Number: 31-8450-0012050897-0001
Policy No: 12-8450-0000030389-04
Inception Date: 19/11/2022
Valid Up to: 18/11/2023
Member Name: Radhabai Ganesh Shinde
Age: 61
Bajaj Allianz General Insurance Company

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance
Regulatory and Development Authority of India [IRDAI] vide Reg No. 113)
Regd.Office: Bajaj Allianz House, Airport Road, Yerwada, Pune-411006 (India)
Cashless hospitalization in network hospitals can be obtained only if this card is produced along
with a letter of authorization from Bajaj Allianz except for emergency cases. This is subject to
terms and conditions of the policy. Please quote your ID number for assistance. Intimation to
Bajaj Allianz Helpline is mandatory in case of any hospitalization.
HOSPITAL ALERT: In emergency, Patient may approach with id card; please call Bajaj Allianz
helpline to verify coverage and cashless authorization.
For help and more information:

Say Hi on WhatsApp on 7507245858, Give a Missed Call on 8080945060, SMS ‘WORRY’ to
575758, Contact our 24-Hour Call Center at 1800-209-5858
Email: Bagichelp@bajajallianz.co.in, Website www.bajajallianz.com
Corporate Identification Number: U66010PN2000PLC015329
Bajaj Allianz General Insurance Co.Ltd. Bajaj Allianz House,Airport Road,Yerwada,Pune - 411006. Reg.No.: 113 CIN: U66010PN2000PLC015329


Policy No: 12-8450-0000030389-04
Valid Up to: 18/11/2023
Member Name: Kokila Ashok Gaikwad
Age: 29




Policy No: 12-8450-0000030389-04
Valid Up to: 18/11/2023
Member Name: Vikas Ganesh Shinde
Age: 35



Certificate for the purpose of deduction under Section 80-D of Income Tax
Amendment Act, 1986
This is to certify that Vikas Ganesh Shinde has paid Rs. 52409 towards Health Insurance premium for HEALTH
GUARD - INDIVIDUAL for the period from 19/11/2022 to midnight of 18/11/2023 under Policy no 12-8450-0000030389-
04
FINANCIAL YEAR AMOUNT(RS)
2022-2023 52408.00
Issue Date: 24/10/2022

Place: AURUNGABAD-Abc East,,3rd Floor,,Chilkathana Midc,,
For & on the behalf of

This certificate must be surrendered to the company for issuance of fresh certificate in case of cancellation of the Policy or any alteration
in the insurance affecting premium.
Notes:
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.
3. In event of incorrect representation of this declaration the liability shall be upon the policy holder.
4. This certificate will not be valid if premium payment has been made in cash.
Policy Verification
Claim Registration

TAX INVOICE
(Customer Copy)
Invoice Number 272210I001006991 Customer ID 130768949
Invoice Date 24/10/2022 Policy No. 12-8450-0000030389-04
Recipient/ Details of Insured Supplier/ Details of Insurer
GSTIN Unregistered GSTIN 27AABCB5730G1ZX
PAN NA PAN AABCB5730G
Name (Proposer) Vikas Ganesh Shinde Name Bajaj Allianz General Insurance Company Ltd.
S/O Ganesh Shinde, 3 June Gaon Thanat Satgaon

Address-1 Address-1 Abc East,
Null Null Null Null
Address-2 NA Address-2 3rd Floor,
Address-3 NA Address-3 Chilkathana Midc,
Pin Code 443106 Pin Code 431210
City BULDHANA City AURANGABAD
State MAHARASHTRA State MAHARASHTRA
Client Category NON HNI Place of Supply 27 - MAHARASHTRA
Premium
Description Amount(INR) Description Amount(INR)
Net Premium 44415 State GST/UTGST(9%) 3997

Receipt Number: 54-22-000000736749 Date: 24/10/2022
Central GST(9%) 3997
Premium Payer ID: 130768949 Float: NA; ** If Premium paid
through Cheque, the Policy is void ab-initio in case of dishonour of 0
IGST(18%)
Cheque
Gross Premium 52409
Total Invoice Value (In figures) : 52409

Total Invoice Value (In Words) : Fifty-Two Thousand Four Hundred Nine Rupees
Amount of Tax Subject to Reverse Charge: No reverse charge is payable on these services.
Services Accounting Code: 997133 Accident and health insurance services.

Principal Location: Bajaj Allianz House, Airport Road, Yerwada, Pune- 411006 PH-66026666
For & on the behalf

Important Notes:
* The invoice is issued as per Section 31 of the CGST Act
* In case no GSTIN or incorrect GSTIN is provided by the Proposer at Proposal stage, Bajaj Allianz General Insurance Company Ltd shall not be responsible for
any Input Tax Credit losses and no subsequent revision of invoice will be undertaken
* As per the GST regulations, the amount of GST will not be refunded if the policy / endorsement is cancelled after 30th September of the next financial year E.
& O.E
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Bajaj Allianz General Insurance Co. Bajaj Allianz House,Airport Road,Yerwada,Pune - 411006. Reg.No.:113 CIN:U66010PN2000PLC015329

Welcome To Bajaj Allianz Family: Insured Name Policy Number Vikas Ganesh Shinde 12-8450-0000030389-04

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Welcome To Bajaj Allianz Family: Insured Name Policy Number Vikas Ganesh Shinde 12-8450-0000030389-04

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Welcome to Bajaj Allianz Family

Insured Name Vikas Ganesh Shinde Policy number 12-8450-0000030389-04

Name: Vikas Ganesh Shinde

Dear Vikas Ganesh Shinde,

For & on the behalf

Signature Not Verified

Give a Missed Call on 808094506 SMS 'WORRY' to 575758 http://www.facebook.com/BajajAllianz

Contact our 24-Hour Call Center at 1800-209-5858 http://twitter.com/BajajAllianz

bagichelp@bajajallianz.co.in Demystify Insurance https://www.bajajallianz.com/blog.html

Phone No 9969722355 Email ID drvickyshinde@gmail.com

Previous Policy No 12-8450-0000030389-03 Previous Policy Expiry Date 18/11/2022

Policy Issued on 24/10/2022 Policy Status ACTIVE

From 19/11/2022 00:00 Hrs To 18/11/2023

GSTIN / UIN Unregistered Place of Supply/State

Company PAN AABCB5730G Invoice No: 272210I001006991

Insured Member Details

Sum Insured & Cover Details

Waiver of Room Capping Non-Medical Expenses Cover Health Prime Rider

Voluntary Co-payment Opted-10%/20% 0 Voluntary Co-payment Discount@10%/20% 0

Premium on Add-on Cover 0 Room Rent Capping Discount 0

Vikas Ganesh Shinde NA

Kokila Ashok Gaikwad NA

Special Exclusion at Policy

AGENCY CODE 10028075 CONTACT NO 09970053177

For & on the behalf

Policy Verification Claim Registration

Give a Missed Call on 8080945060, SMS 'WORRY' to 575758 http://www.facebook.com/BajajAllianz

Contact our 24-Hour Call Center at 1800-209-5858 http://twitter.com/BajajAllianz

bagichelp@bajajallianz.co.in Demystify Insurance https://www.bajajallianz.com/blog.html

Proposer Name Vikas Ganesh Shinde Policy Number 12-8450-0000030389-04

Receipt Number 54-22-000000736749 Receipt Date 24/10/2022

Received with thanks from: Vikas Ganesh Shinde

Online Payment 95623172 24-Oct-2022 BN00000146 BN00000146 52,409.00

Total Amount: 52409

For & on the behalf

Give a Missed Call on 8080945060, SMS 'WORRY' to 575758 http://www.facebook.com/BajajAllianz

Contact our 24-Hour Call Center at 1800-209-5858 http://twitter.com/BajajAllianz

bagichelp@bajajallianz.co.in Demystify Insurance https://www.bajajallianz.com/blog.html

Gender Male Date of Birth 27/02/1987

PAN No ERLPS4409H UID/Unique ID NA

Bajaj Allianz Employee Code, if Proposer is BAGIC/BALIC Employee NA

Marital Status Married No of children NA

Address Line 2 NA Address Line 2 NA

Address Line 3 NA Address Line 3 Mhasla Bk

City/District Buldhana City/District Buldhana

State Maharashtra State Maharashtra

Pin Code 443106 Pin Code 443106

Telephone 9969722355 Telephone 9969722355

Mobile 9969722355 Mobile 9969722355

Email drvickyshinde@gmail.com Email drvickyshinde@gmail.com

Family Monthly Income 0

In case of any offer, you would prefer to be contacted by 9969722355,drvickyshinde@gmail.com

Policy Period 1 Year

Sum Insured Options

a) Health Guard Individual Sum insured 300000

b) Health Guard Family Floater Sum Insured NA

Details of the Persons to be Insured

Member Name Health Questionnaire Yes/No Details

Member Name Health Questionnaire Yes/No Details

Member Name Health Questionnaire Yes/No Details

Radhabai Ganesh Do you or any of the family members to be covered No NA

A. EXCLUSIONS AND TERMS AND CONDITIONS:

Give a Missed Call on 8080945060, SMS 'WORRY' to 575758 http://www.facebook.com/BajajAllianz