ACKO GENERAL INSURANCE LIMITED

Subject : This is about the claim you filed under Policy No. FKINSR01067410944 on Feb 27, 2024

Hi Subham Debnath,
Based on the facts present now, we are unable to honor your claim. We have detailed our reasons below:

• Claim No : FKINSR01067410944-C03
• Date of Incident : Feb 22, 2024
• Date of Claim Notification : Feb 27, 2024
• Claim Type : Hospital Daily Allowance
• Policy Duration : 26 October, 2023 - 25 October, 2024
• Group Administrator : Flipkart Internet Private Limited (“Flipkart”)

Upon scrutiny of the discharge summary, it was observed that discharge summary is forged indicating tha
t documents have been manipulated for claiming undue benefit . Hence, the claim does not fall under the
policy T&C.

We wish to bring to your notice that “Dishonest & Fraudulent Claims” under the “Group Health Insurance”
policy, which is mentioned as below,

“If any claim is in any manner dishonest or fraudulent or is supported by any dishonest or fraudulent
means or devices, whether by You or any Insured Person or anyone acting on behalf of You or an
Insured Person, then this Policy Schedule / Certificate of Insurance will be void, and all benefits
otherwise payable under it will be forfeited.”

If you believe that we have overlooked any material fact or circumstance or wish to present an alternative
interpretation of any relevant policy provision, please bring it to our attention at the earliest by contacting
our Claims Internal Grievance Department (address below), with details for resolution.

Address of Claims Internal Grievance Department:

Grievance Redressal Officer

ACKO GENERAL INSURANCE LIMITED.,
2nd Floor, Acko General Insurance
36/5 Hustlehub One East, Somasandrapalya,
27th Main Road, Sector 2, HSR Layout,
Bangalore, Karnataka – 560102
Email: gro@acko.com
Phone: +91 80-62370005 / +91 80-37680069

Please note that we reserve the right to stay with our decision or modify it after reviewing the new facts or
circumstances that are shared with us. And if you are unhappy with the resolution, you may reach out to
the Insurance Ombudsman of your jurisdiction. Click here to find your Ombudsman’s address.

Thanks
Team ACKO

2nd Floor, #36/5, Hustlehub One East, Somasandrapalya, 27th Main Rd, Sector 2, HSR Layout, Bengaluru, Karnataka 560102
Contact no: 080 6832 3600 | Email : hello@acko.com | Website : www.acko.com | CIN: U66000KA2016PLC138288 | IRDAI Regn. No. 157