Cashless Claim Reference Number: (36951951)

(Please quote this reference number in all future correspondence)

Date :08 Mar 2024

Dear Insured,

Your Claim has been received. The details of the claim are as follows:

Patient Details

Patient Name Gudime Bharati

Insurance Company The New India Assurance Co. Ltd

Medi Assist ID 5119689359

Policy Holder SBI Life Insurance Company Ltd

IP No.

Policy No. 12020034230400000027

Primary Beneficiary Kailas Praveen Kumar

Employee ID 67573

Insurer Claim No TP00312020023900023334

Insurer Member ID MEMBER93548

QUICK LINKS:

For partner hospital

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For member beneficiary

Track this claim on Medi Assist

Warm Regards,

Medi Assist Insurance TPA Pvt. Ltd

(Formerly known as Medi Assist India TPA Private Limited) CIN: U85199KA1999PTC025676. Regd Off: Tower "D", 4th floor, IBC Knowledge Park, 4/1, Bannerghatta Road, Bangalore - 560
029.

Disclaimer: The TPA extends the cashless facility subject to the standard terms & conditions of the policy and the information provided in the cashless request form. We suggest that the
patient continues with the treatment as advised by the treating doctor, irrespective of the pre-authorization/cashless facility.

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