Vishnu Patni

Letter For Customer Page 1 of 5
Group Credit Secure

Certificate of Insurance
Issuing Office: AHMEDABAD Intermediary Name : DIRECT
Policyholder’s Name: MRS SHARDABEN MANOJBHAI PATNI Intermediary License Code : NA
Policyholder’s Address: S 153 PATAN NAGAR V2
NR KHODIYAR NAGAR
CHAR RASTA NIKOL RD
Intermediary Contact Details : 24*7 Tollfree Helpline
AHMEDABAD - 382430
AHMEDABAD 1800-266-7780
GUJARAT
INDIA
Master Policy Number: 0235000076 002694 00 Branch Code : 0220
Certificate Number: 002694 Business Type: New Business
Application Number: 10334850
Name of lending institution: TATA CAPITAL HOUSING FINANCE LIMITED
Policy Tenure: 3 Years Years
Certificate Effective From:21/06/2018 00:00 AM to 20/06/2021 23:59PM
1. Name of the Proposer MRS SHARDABEN MANOJBHAI PATNI

2. Date of Birth 13/05/1991
3. Relationship Self
4. Sum Insured (in ) 1040000
5. Basis of Sum Insured Fixed
6. Contact Details Tele. (Resi) :
Tele. (Off) :
Fax. :
Mobile : 8866970446
Email Id :
7. Insured Premises Address MARUTI RESIDENCY 2 NR SINGARVA BUS STOP SINGARVA AHMEDABAD GJ
382430
8. Pre-existing disease* Nil
Details of Co-applicant:
* in case of any discrepancy with regards to pre-existing disease information, kindly contact our toll free no or write to us on
immediate basis on receipt of this document.
Insurance is the subject matter of the solicitation. For more details on risk factors, terms and conditions, please read sales brochure
carefully before concluding a sale.
TATA AIG General Insurance Company Ltd. Regd. Office: 15th floor, Tower A, Peninsula Business Park,Ganpatrao Kadam Marg, Off
Senapati Bapat Marg, Lower Parel, Mumbai- 400 013.
IRDA Registration No.108, CIN No : U85110MH2000PLC128425, PAN : AABCT3518Q UIN No : IRDAI/HLT/TAGI/P-H(G)/V.I/51/2016-
17
Website: www.tataaig.com 24X7 Tollfree Helpline 1800-266-7780 E-mail: customersupport@tataaig.com
http://iip-core.tataaiginsurance.in/Configurator/UnderwrittingMasters/Reports/frmDTMLett... 1/7/2019
Nominee Details:
Nominee Name Relationship with proposer
MANOJBHAI PATNI Spouse
Policy Coverage & Benefits:
Co-applicant
Sl. No Benefits Applicant
1 2 3
1 Critical Illness - Sum Insured (Rs) 1040000.00
2 Accidental Death - Sum Insured (Rs) 1040000.00
Accidental Permanent Total Disability -
3 1040000.00
Sum Insured (Rs)
4 Education Benefit - Sum Insured 104000.00
5 Involuntary loss of Employment NA
Fire & Special Perils including Earthquake:
a.Earthquake – Building 0
6 b.Fire – Building 0
c.Riot Strike Malicious Damage- Building 0
d.Storm Cyclone Typhoon Tempest -Building 0
Enclosures: This is only a summary of the product features. The actual benefits available are as described in the policy wordings and
will be subject to the enclosed policy terms, conditions and exclusions.
PREMIUM DETAILS
Total Premium ( ) 12324
UGST/SGST @9 % ( .) 1,109.16
CGST @9 % ( .) 1,109.16
Total Premium Amount Payable ( ) 14542
17
The stamp duty of Rs 52/-paid in cash or demand draft or by pay order,vide Receipt/Challan no:MH000857784201819E dated the
24/04/2018.
80 D certificate of Income Tax Act, 1986

This is to certify that the SHARDABEN MANOJBHAI PATNI has paid an amount of Rs 9,038.06 towards the premium for the Critical
Illness benefit under Group Credit Secure Certificate No 002694 for the period From 21/06/2018 To 20/06/2021 and is eligible for a
tax exemption under section 80 D of IT Act.
Section 41 of Insurance Act 1938 (Prohibition of rebates):

1. No person shall allow or offer to allow either directly or indirectly as an inducement to any person to take out or renew or
continue an insurance in respect of any kind of risk relating to lives or property in India, any rebate of the whole or part of
the commission payable or any rebate of premium shown on the policy, nor shall any person taking out or renewing or
continuing a policy accept any rebate, except such rebate as may be allowed in accordance with the published prospectus or
tables of the insurer.
Any person making default in complying with the provisions of this section shall be liable for penalty which may extend to ten
2.
lakh rupees.
Commencement of risk cover under the policy is subject to receipt and realization of premium by Tata AIG General
Insurance Company Limited
For Tata AIG General Insurance Company Limited
Authorized Signatory
IRDA of India Registration No.:108

CIN: U85110MH2000PLC128425
Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen)
Visit us at www.tataaig.com
17
RECEIPT
Receipt No. : 102201006588113 Receipt Date : 21/06/2018
Policy No : 0235000076 002694

00
Received with thanks from TATA CAPITAL HOUSING FINANCE LTD a sum of 14,542.00 ( Rupees Fourteen
Thousand Five Hundred Forty Two And Paise 00 Only)
Utilized from the receipt

Sr. Policy
Total Premium ( ) for Balance ( )
No. Number
policy ( )
1 0235000076 002694 00 14,542.00 14,542.00 0.00
Note:
1. This is a computer generated receipt and does not require a signature.
2. Upon issuance of this Receipt, all previously issued temporary receipts, if any, related to this Policy shall be
considered null and void.
3. Amounts received by cheque shall be subject to realisation.
4. Any amount received in excess of the Premium is being/shall be refunded by the Company.
GSTIN : 24AABCT3518Q1Z2 - GUJARAT Service Accounting Code : 9971
Revenue (consolidated) Stamp Duty duly paid vide challan No.MH010797271201718E date 19/02/2018 for applicable
cases.
Insurance is the subject matter of the solicitation. For more details on risk factors,
terms and conditions, please read sales brochure carefully before concluding a
sale.
TATA AIG General Insurance Company Ltd. Regd. Office: 15th floor, Tower A,
Peninsula Business Park,Ganpatrao Kadam Marg, Off Senapati Bapat Marg, Lower
Parel, Mumbai- 400 013.
IRDA Registration No.108, CIN No : U85110MH2000PLC128425,PAN :
AABCT3518Q
Website: www.tataaig.com 24X7 Tollfree Helpline 1800-266-7780 E-mail:
customersupport@tataaig.com

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Letter For Customer Page 1 of 5

Group Credit Secure

Certificate Effective From:21/06/2018 00:00 AM to 20/06/2021 23:59PM

1. Name of the Proposer MRS SHARDABEN MANOJBHAI PATNI

Policy Coverage & Benefits:

80 D certificate of Income Tax Act, 1986

Section 41 of Insurance Act 1938 (Prohibition of rebates):

For Tata AIG General Insurance Company Limited

IRDA of India Registration No.:108

Receipt No. : 102201006588113 Receipt Date : 21/06/2018

Policy No : 0235000076 002694

Utilized from the receipt

GSTIN : 24AABCT3518Q1Z2 - GUJARAT Service Accounting Code : 9971

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