Deficiency Letter

Without Prejudice

To Date 11/MAR/2024

RAMAN GARG, Claim No (CCN) RR-FC23-

--,NA 14116299

,,
KAITHAL,HARYANA,136027,
Contact No.-7206221859

Subject : Additional Document Requirement for RR-FC23-14116299 (CCN no)

Reference Details:

Policy No 2805204589848901 HDFC ERGO ID ER2220072122-01E

Employee / Proposal Name RAMAN GARG Employee Code NA

Patient Name Raman garg Policy Validity 10/APR/2024

Hospital Name DR LAL PATH LABS LTD DOA 05/03/2024

Ailment / Disease Encounter for general adult medical DOD 05/03/2024

examination without abnormal
findings

Dear Sir/Madam
We have received claim documents pertaining to above Captioned Claim.

We have scrutinized the documents and from the information gathered during the course, we observe that following documents / Information
necessary for further processing is not provided

1.any of the following documents for National Electronic Funds Transfer (NEFT) - cancelled cheque / bank passbook with bank stamp / bank
statement for last 3 months with stamp of the bank, bearing printed name of the proposer ( RAMAN GARG
) with his/her signature and IFSC code (if name not printed in cheque, then bank passbook copy/ bank statement copy duly attested by bank
authority for NEFT). In case of name correction requirement, please contact our Health Claim Services team and kindly get the correct name
endorsed.

Documents to be sent to below mentioned address:

HDFC ERGO General Insurance Company Ltd.

Stellar IT Park, Tower-1,
5th floor, C-25, Sector-62,
Noida-201301

Please note that the conclusion regarding the eligibility of coverage / admissibility amount can be decided once we have the full set of original
documents

Kindly quote the Claim Control Number (CCN) RR-FC23-14116299 for all future correspondence regarding this claim.m

HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 Customer Service Address: D 301, 3rd Floor,
CIN: U66030MH2007PLC177117, Registered & Corporate Office: 1st Floor, HDFC House, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078.
165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service No : +91 22-62346234 / +91-120 6234 6234 | www.hdfcergo.com
 Authorized Signatory

HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 Customer Service Address: D 301, 3rd Floor,
CIN: U66030MH2007PLC177117, Registered & Corporate Office: 1st Floor, HDFC House, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078.
165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service No : +91 22-62346234 / +91-120 6234 6234 | www.hdfcergo.com