To,

Date: 15/03/2024
ERICSSON INDIA PRIVATE LIMITED EGIL
EGIL62811 Shortfall Letter No: GUR-0324-CL-0004980-S01
Address U/W Claim Number:
KNOWLEDGE BOULEVARD, TOWER A, PLOT NO 8A, Agent Code:
GAUTAM BUDDHA NAGAR Dev off Code:
NOIDA,UTTAR PRADESH
Pin code: 201301
Phone no: 9321164286

Sub:Query pertaining to claim GUR-0324-CL-0004980

Proposer/Insured Name ERICSSON INDIA PRIVATE LIMITED EGIL/ABDUL AHAD

Policy number 50569000202300
MOHAMMAD FAROOQUE SIDDIQUI
Employee Code EGIL62811 ID Card number GUR-MB-E0538-011-0012462-A

Patient name ABDUL AHAD MOHAMMAD FAROOQUE SIDDIQUI Hospital name JILLA IVF CENTER

Date of Admission 06-Feb-2024 Date of Discharge 06-Feb-2024

Claim Amount 28240 Claim number GUR-0324-CL-0004980

Dear Sir/Madam,
With reference to your claim paper submitted with us you are requested to provide us with the following details to enable us to process your claim further.

1. ~PLEASE PROVIDE A CANCELLED CHEQUE HAVING IFSC CODE, A/C NUMBER AND NAME OF THE INSURED PRINTED ON IT
~PLEASE PROVIDE INVESTIGATION REPORT IN SUPPORT OF DIAGNOSIS

Important
Please note that the above claim is being assessed based on the assumption that all your bills have been submitted to us.

Please also note that issuance of this query letter, does not amount to acceptance/clearance of your claim. On receipt of the above documents, your claim will be
processed in accordance with the Terms and Conditions of the Policy. Please quote the above query number in your query reply and also for any further
correspondence with regards to the claim.

For any further assistance please feel free to write us on null or call us at our 24x7 call center numbers

Printed on : 15/03/2024

This is computer Generated letter and does not require signature