HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited
2952200906290802000
MR. CHIRANJIB PATRA
691 SIDDHESWARITALA KAMARPARA BARRACKPUR FLT D2 .
KOLKATA, 700120
WEST BENGAL
Contact No : 9831518949
We have secured your health last year and we are happy to have the privilege of serving you again this year as well.
Your Health insurance policy reference no 2952200906290802000 has been renewed successfully.
For your convenience we have implemented a Lifetime Validity Health Card. For you,this simply means that the Health card issued at the time of first
policy purchase is valid throughout and as long as your policy is active with us.
We look forward to serving you in future and wish you a safe and secure year ahead.
For HDFC ERGO General Insurance Company Ltd.
Ankur Bahorey
Head - Retail Business Group
Dear MR. CHIRANJIB PATRA
Subject : Certificate for the purpose of deduction under section 80 D of Income Tax (Amendment) Act, 1986
This is to certify that we have received an amount of ` 9,458.00 (RUPEES NINE THOUSAND FOUR HUNDRED FIFTY EIGHT
AND ZERO PAISE Only) towards premium for Bancassurance Health Product, Policy No. issued to CHIRANJIB PATRA for the
period 28/11/2018 to 27/11/2020.
Note:
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. In event of incorrect representation of this declaration the liability
shall be upon the policy holder.
Date : 25/11/2018 For HDFC ERGO General Insurance Company Ltd.
Policy Issuing Office: Mumbai
Duly Constituted Attorney
HDFC ERGO General Insurance Company Limited.(Formerly HDFC General Insurance Limited from Sept 14, 2016 and L&T General Insurance Company Limited upto Sept 13, 2016).CIN: U66030MH2007PLC177117.
Registered & Corporate Office: 1st Floor,HDFC House, 165 - 166 Backbay Reclamation,H. T. Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service Address: D-301, 3rd Floor, Eastern Business District
(Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078. Toll Free Number: 1800 2700 700 Te.: +91 22 6638 3600 | Fax: 91 22 6638 3699 | care@hdfcergo.com | www.hdfcergo.com.
UIN : HDE-MO-P14-40-V02-14-15 IRDAI Reg No.146
Policy Schedule
Policy No. 2952 2009 0629 0802 000 Health Suraksha Silver Plan
Proposer Name MR. CHIRANJIB PATRA PAN No. Premium Frequency Yearly
Corr. Address/ 691 SIDDHESWARITALA KAMARPARA,BARRACKPUR FLT D2 Permanent 691 SIDDHESWARITALA KAMARPARA,BARRACKPUR FLT D2 .,,,
0
Place of Supply .,,, Address KOLKATA, WEST BENGAL, 700120

KOLKATA, WEST BENGAL, 700120
Mobile 9831518949 Phone - E Mail CHIRANJIBPATRA@GMAIL.COM Policy Type Individual
Period of Insurance From Date & Time 28/11/2018 00:01 hrs To Date & Time 27/11/2020 Midnight Policy Issuance Date 25/11/2018
Insured Person’s Details & Sum Insured
Insured's Name Relationship Date of Birth Member ID 1st Policy Portability Pre Existing
Inception Sum Insured (`) Disease
CHIRANJIB PATRA Self 10/05/1973 28/11/2012
Sum Insured (`) 200,000.00 CB Amount (`) 60,000.00
In case of increase in the Sum Insured at renewal, waiting period will apply afresh in relation to the amount by which the Sum Insured has been enhanced.
Nominee Name Relationship

The nominee must be an immediate relative of the Insured Person. For all other insured person(s), the Policyholder shall be the nominee.
Coverage Details
Coverage Details Coverage Details

Pre-hospitalization (days) 60 Post-hospitalization (days) 90
Ayurvedic /Unani/Sidha/ Homeopathic Covered Day Care Procedures Covered
Domiciliary Treatment Covered In-Patient Treatment Covered
Organ Donor Expenses Hospital Daily Cash (only to the eldest member Rs.1000/- per day for a maximum of
Covered
of the family) 30 days
Health Check up per family (Post 4 Claims free Upto 1% Sum Insured,Maximum Upto Rs Emergency Ambulance Charges (Limit per
Upto Rs.2,000/-
years) 5000/- hospitalisation)
The Policy Wording includes all the standard coverages offered b y the Company to its customers. Your entitlement for coverage/benefits shall be restricted to the coverage/benefits a s mentioned in this Policy
Schedule issued to you. Please read the Policy Wording in conjunction with the Policy Schedule. For any clarification, please call our toll free number.
Subject to the conditions laid down in the Policy, on completion of each four consecutive policy years with us, the eligible Insured Person(s), included in each policy year is/are entitled for a medical checkup benefit
up to an amount equals to 1% of sum insured or Rs 5000/- whichever is less.
Premium Details (`)

Basic Premium 8,015.00
Loadings 0.00
GST 18% : Central Tax 9%( `847.50)+ State Tax 9%( `847.50) 1,443.00
Total Premium 9,458.00
Payment Details
Cheque No./DD/Fund Transfer Date Bank Name
HI1811010790 25/11/2018 BizDirect
Special Conditions
Age proof/identity proof will be collected in event of claim under the policy.
Exclusions
NA
Invoice No. 2009062908020001 HSN Code 9971

For Claim Services Phone 1860 2000 700 / 1800 2001 999 Fax no. 18602000600 E-mail healthclaims@hdfcergo.com
Processing Centre HDFC ERGO General Insurance Company Ltd. 5th floor, Tower 1, Steller IT Park, C-25, Sector-62,Noida-201301.
For any other query call toll-free 1800 2 700 700 or email us at care@hdfcergo.com or log on to www.hdfcergo.com
If the premium is not realised the policy shall be void from inception.
Consolidated stamp duty for this Insurance Policy is paid by Demand Draft, vide Receipt/Challan no CSD/137/2018/3774/18 dated 30/08/2018 as prescribed in Government Notification Revenue and Forest
Department No. Mudrank 2004/4125/CR 690/M-1,dated 31/12/2004., dated 31/12/2004. , Goods and Service Tax Registration No: 19AABCL5045N1Z5. Goods and Service Tax for this invoice is not payable under
reverse charge basis.
Branch : METRO TOWERS,10 TH FLR, 1 HO CHI MINH SARANI,KOLKATTA - 700 071 KOLKATA, 700071. Phone No. : +91-22-39883600
Policy Schedule
Policy No. 2952 2009 0629 0802 000
Health Suraksha Silver Plan

Agent Name :HDFC BANK LTD
Agent Code :201587086428 Tel No. :61606161
*1*
#1#
*$*Nagendra Saikumar#$#
HDFC ERGO General Insurance Company Limited 1

Policy No.:2952200906290802000 This card is for identification purpose only.
Valid From: 28/11/2018 Renewal Date: 27 November
Card has to be presented to the Network Service Provider at the time of admission/ availing
cashless hospitalization o r any other services. Insurance claim will be processed in accordance
Insured Name Date Of Birth Gender with the policy term & conditions. Card does not guarantee cashless hospitalization or any other
service. For more details and updated list of Network Service Provider please refer our website or
CHIRANJIB PATRA 10/05/1973 Male call our call centre. This card is valid till the time policy is active.
Phone Number : 1800 2 700 700

Fax Number : 18602000600
Email : healthclaims@hdfcergo.com
Processing Centre : HDFC ERGO General Insurance Company Ltd. 5th floor,
Tower 1, Steller IT Park, C-25, Sector-62,Noida-201301.
Website : www.hdfcergo.com
HDFC ERGO General Insurance Company Limited YES
Policy Schedule
Policy No. 2952 2009 0629 0802 000
Sarv Suraksha - Personal Accident
HEALTH AHEAD
0
Proposer Name MR. CHIRANJIB PATRA PAN No. Premium Frequency Yearly
Corr. Address/ Permanent 691 SIDDHESWARITALA KAMARPARA,BARRACKPUR FLT D2 .,,, 0
691 SIDDHESWARITALA
Place of Supply KAMARPARA,BARRACKPUR FLT D2 .,,, Address KOLKATA,WEST BENGAL,700120
KOLKATA,WEST BENGAL,700120
Mobile 9831518949 Phone - E Mail CHIRANJIBPATRA@GMAIL.COM Policy Issuance Date 25/11/2018
Period of Insurance From Date & Time 28/11/2018 00:01 hrs To Date & Time 27/11/2020 Midnight Territorial Limits India
Insured Details
Insured’s Name Relationship Date of Birth Benefit
CHIRANJIB PATRA Self 10/05/1973 100%
Nominee Details
Insured’s Name Nominee Name Relationship Benefit
CHIRANJIB PATRA MAHUYA MUKHOPADHYAY PATRA SPOUSE 100%
Coverage Details
Coverage* Sum Insured ( `)
1. Accidental Death
2. Permanent Partial Disability 1,000,000
3. Permanent Total Disability
The Policy Wording includes all the standard coverages offered b y the Company to its customers. Your entitlement for coverage/benefits shall be restricted to the coverage/benefits a s mentioned in this
Policy Schedule issued to you. Please read the Policy Wording in conjunction with the Policy Schedule. For any clarification, please call our toll free number.
Premium Details ( `)
Basic Premium 1,400.00
Loadings 0.00
GST 18% : Central Tax 9%( `847.50)+ State Tax 9%( `847.50) 252.00
Total Premium 1,652.00
Payment Details
Cheque No./DD/Fund Transfer Date Bank Name
HI1811010790 25/11/2018 BizDirect
Special Conditions
Age proof/identity proof will be collected in event of claim under the policy.
Invoice No. 2009062908020002 HSN Code 9971

For Claim Services Phone 1800 2 700 700 Fax no. 022 66383699 E-mail care@hdfcergo.com
Processing Centre 6th Floor, Leela Business Park, Andheri-Kurla Road, Andheri(E), Mumbai 400 059.
For any other query call toll-free 1800 2 700 700 or email us at care@hdfcergo.com or log on to www.hdfcergo.com
If the premium is not realised the policy shall be void from inception.
The stamp duty of ` /-paid by Demand Draft, vide Receipt/Challan no CSD/137/2018/3774/18 dated 30/08/2018 as prescribed in Government Notification Revenue and Forest Department No.
Mudrank 2004/4125/CR 690/M-1,dated 31/12/2004., dated 31/12/2004.Goods and Service Tax Registration No: 19AABCL5045N1Z5. Goods and Service Tax for this invoice is not payable under
Branch : METRO TOWERS,10 TH FLR, 1 HO CHI MINH SARANI,KOLKATTA - 700 071 KOLKATA, 700071. Phone No. : +91-22-39883600
Agent Name :HDFC BANK LTD

Agent Code :201587086428 Tel No. :61606161

HDFC ERGO General Insurance Company Limited

Încărcat de

Informații document

Titlu original

Drepturi de autor

Formate disponibile

Partajați acest document

Partajați sau inserați document

Opțiuni de partajare

Vi se pare util acest document?

Este necorespunzător acest conținut?

Drepturi de autor:

Formate disponibile

HDFC ERGO General Insurance Company Limited

Încărcat de

Drepturi de autor:

Formate disponibile

HDFC ERGO General Insurance Company Limited

For HDFC ERGO General Insurance Company Ltd.