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Date : 4 March 2020

Mr Prakash Joshi

S/O Mukund Shridhar Joshi,Ward No -40,

J.J Hospital Ke Samne Torwa Basti,Bilaspur

Bilaspur

Bilaspur 495001

Chhattisgarh

Policy No. : 17017375

Mobile No. : 9826159924

Dear Mr Prakash Joshi,

Welcome to a world where what matters, above all, is your Health....Hamesha!

Welcome to Religare Health Insurance.

At Religare, it's our mission to provide you access to the highest quality of healthcare and put you back on the road to a worry-free recovery,
without a care about medical bills and other related expenses. Moreover, as a member of a group that is driven by innovation and constantly aims
at creating value, you can expect an unmatched bouquet of products and services.

Thank you for choosing Secure - A Personal Accident Cover that directly addresses every concern which can arise as a result of a serious accident.
To help you understand our benefits & services better, please go through the 'Know your policy better' kit that accompanies this letter and
constitutes the following details:

Policy Certificate
Premium Acknowledgement
Key Policy Information
Policy Terms and Conditions
Claim Process

What’s more ! Our policy comes with a free-look period of 15 days from the date of receipt. Hence, after purchasing the policy, if you find it
unsuitable, you can cancel and return the policy to us.

To further simplify procedures, we're online at www.religarehealthinsurance.com; where you can view network hospitals across the country, cashless
procedures and do much more.

For any assistance feel free to mail us at customerfirst@religarehealthinsurance.com or call 1800-102-4488.

Once again, we thank you for this opportunity to serve you, and wish you and your loved ones good health always!

Team Religare Health Insurance

Religare Health Insurance Company Limited

Correspondence address : Unit no 604 - 607, 6th Floor, Tower C, Unitech Cyber Park, Sector 39, Gurgaon -122001.(HARYANA)
www.religarehealthinsurance.com
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Policy Certificate

Policy No. 17017375

Mr Prakash Joshi Plan Name
Cover type
S/O Mukund Shridhar Joshi,Ward No -40, Policy Period - Start Date
J.J Hospital Ke Samne Torwa Basti,Bilaspur Policy Period - End Date
Nominee Name (Relation)
Bilaspur
Premium Paid
Bilaspur 495001
Chhattisgarh 22 Premium Payment Mode
Secure - 2
Individual
00:00 hrs 28-Feb-2020
Midnight 27-Feb-2023
Jyoti Joshi (Wife)
Rs. 10410
(Premium Rs 8822.25 + CGST Rs 793.98 +
IGST Rs 0 + SGST Rs 793.98 + UGST Rs 0)
Single Premium

Policyholder Date of Birth Client ID

Prakash Joshi 11-Jan-1957 75264065

Details of Insured

Name Client ID Date of Birth Relationship Insured with the Company (since)

Prakash Joshi 75264065 11-Jan-1957 Member 28-Feb-2020

1 Details of Cover
S No. Particulars Details
1 Sum Insured Rs. 15,00,000

Intermediary Details
Name Code Contact Number
Robinhood Insurance Broker
20000292 9820225238
Private Limited

for Claims & Assistance: Call 1800-102-4488

01 4
Benefits
S No. Particulars Basis of Offering (On Annual Basis)
1 Accidental Death 100% of Sum Insured

2 Permanent Total Disablement As per clause 2.2

3 Permanent Partial Disablement as per clause 2.3

4 Fracture Up to 100,000

5 Child Education 10% of Sum Insured

6 Major Diagnostic Test Up to 15,000

7 Disappearance 100% of Sum Insured

8 Mobility Cover Up to 15,000

9 Burn Up to 10 lacs

Per policy year 5% increase in Sum Insured, Maximum increase up to

10 Loyalty Benefit 50% of Sum Insured

11 Accidental Hospitalization Up to 50,000

12 Temporary Total Disablement Up to Rs 10000 per week, Maximum up to 100 weeks

13 PTD Improvement as per clause 2.16

14 PPD Improvement as per clause 2.17

For Religare Health Insurance Company Limited

Authorized Signatory Date of Issue : 04-Mar-2020 Place of Issue : Gurgaon, Haryana

Service Branch : RHICL, #136 , Lower Basement Shyam Square, Pandri,Opp. Lic Building, , Raipur, Chattisgarh - 492004 Branch Contact No. : 1800-102-4488
Correspondence Address: 04-Ma
Religare Health Insurance Company Limited
Unit no 604 - 607, 6th Floor, Tower C, Unitech Cyber Park, Sector 39, Gurgaon -122001.(HARYANA) Contact No : 1800-102-4488
Website : www.religarehealthinsurance.com Email : customerfirst@religarehealthinsurance.com
Consolidated Stamp Duty paid vide E-Challan GRN no. 61347960 dated 27 Dec 2019, RCM Applicability- N/A
SAC: 997133 and Description of Service: Accident and Health Insurance Services State GSTIN No.: 22AADCR6281N1Z2 IRDA Registration Number - 148 UIN: RHIPAIP18048V021718
Registered office address : 5th Floor, 19 Chawla House, Nehru Place, New Delhi - 110019
CIN : U66000DL2007PLC161503

Note:
Attached with this Policy Certificate are the Policy Terms & Conditions, Add-on Benefits (if opted) and Annexures. Please ensure that these documents have been received, read and understood. If any of
these documents have not been received, please email <customerfirst@religarehealthinsurance.com> or contact the Company at <1800-102-4488>. This Policy Certificate in original must be
surrendered to the Company in case of cancellation of the Policy. Summary of matters that are stated in the Policy terms and conditions to comply Regulation 7 of Protection of Policyholders' Interests,
2002 and a copy of the Key Policy Information are also enclosed herewith.
0 NB

Premium Acknowledgement

Policy No. 17017375

Client ID 75264065
Policyholder Mr Prakash Joshi
Address S/O Mukund Shridhar Joshi,Ward No -40,
J.J Hospital Ke Samne Torwa Basti,Bilaspur
Bilaspur
Bilaspur 495001, Chhattisgarh
Policy Period 28-Feb-2020 to 27-Feb-2023

Premium Details
Particulars Amount (in Rs.) 8,2

Gross Premium
Secure 2 7,047.00
-Accidental Hospitalization 1,188.00
-PPD Improvement 238.95
-PTD Improvement 170.10 V
-Temporary Total Disablement 178.20

Goods & Services Tax (GST) 1,587.96

Total 10,410.00

The Premium is rounded off to the nearest rupee.

For Religare Health Insurance Company Limited

Authorized Signatory Date of Issue: 04-Mar-2020 Place of Issue: Gurgaon, Haryana

This Mr fro 882 towa
Registered office address : 5th Floor, 19 Chawla House, Nehru Place, New Delhi - 110019
CIN : U66000DL2007PLC161503

Note
1) In case of any discrepancy, the Policyholder is requested to contact the Company immediately.
2) This document must be surrendered to the Company in case of Cancellation of the Policy or for the issuance of a fresh certificate in the case of any alteration in the Policy.
 1

Proposal Form-'Secure 2'

Dear Mr Prakash Joshi

In reference to your online proposal (3120011442654) for Secure 2- Personal Accident policy, please find below the details as provided by you:

Proposer Details

Name : Mr Prakash Joshi

Address : S/O Mukund Shridhar Joshi,Ward No -40,

J.J Hospital Ke Samne Torwa Basti,Bilaspur
Bilaspur
Bilaspur-495001
Chhattisgarh

Date of Birth : 11/01/57

Landline :

Mobile : 9826159924

E-mail : prakashjoshi@gmail.com

Details of the Persons be Insured

Date of Pre-existing
Name Relation Annual Income Occupation Occupation Class
Birth Diseases
C5/tetiard labour
PRAKASH JOSHI 11/01/57 MEMBER NONE 400,000.00 Salaried inspectore

Additional Details
A. Does your job require you to engage in significant manual labor or hazardous activities or requires handling hazardous material or working at
significant heights or with high voltage

Insured 1
No
B. Have you ever been diagnosed or are under treatment for any terminal illness or any illness/disease restricting your activities (e.g. Epilepsy/Seizure
disorder)
Insured 1
No

C. Any existing Disability/Deformity (physical or mental impairment/infirmity or any condition hampering vision, hearing or mobility)

Insured 1
No
D. Has any company ever declined to issue/renew a Personal Accident policy for any proposed? If yes, please provide details

Insured 1
No
Occupations Code Descriptions *
Occupation Code C1: Employees without exposure to manual work outside Office (Admin/Finance and Accounting /Sales & Marketing / BPO/IT /Actuaries
/Audit/Operations/HR/R&D)
Occupation Code C2: Professionals without exposure to manual work outisde office(Academicians/Healthcare/Legal/Consultants/Architects/Engineer/Real-Estate)
Occupation Code C3: Technicians/Mechanics(Except Heavy machinery Operators/Electrician/Nuclear and chemical Lab Technician)
Occupation Code C4: Business owners (Excluding Chemical, Arms and Ammunitions,Explosives, Fireworks)
Occupation Code C5: As mentioned
 You agreed to following terms & conditions of the purchase of policy
a. I have read and understood the brochure/prospectus/sales literature/Terms and Conditions of the Policy and confirm to abide by the same.
b. Receipt of proposal form by the Company shall not be construed as acceptance of proposal. Commencement of risk under the Policy shall be subject to realization of full
premium and individual underwriting by the Company. The Company at its sole discretion reserves the right to accept or reject or load any proposal. Policy would start
from the date as specified in the Policy Certificate.

c. I understand that the Policy Period Start Date as specified in the Policy Certificate shall be from the 00:00 hours of the next day of the Proposal receipt at branch,
proposed policy period start date as opted by me or cheque date, whichever is later.

d. I understand that the Policy shall become void at the Company's option, in the event of any untrue or incorrect statement, misrepresentation, non-description or
non-disclosure of any material fact, in the proposal form/personal statement, declaration and connected documents or any material information having been withheld by
me or anyone acting on my behalf.

e. I consent to and authorize the Company and/or any of its authorized representative agents to seek medical information from any hospital/medical practitioner or any other
related entity that I have attended or may attend in future concerning any illness or injury.
f. I consent to provide a valid age proof and identity proof at the time of claims or any other time when required by the Company. h.I authorize the Company to exchange,
share or part with the information relating to myself/person(s) to be insured with any external entity other than regulatory and statutory bodies, as may be required and I
will not hold the Company or its agents liable for use/sharing of this information.

g. I authorize the Company to exchange, share or part with the information relating to myself/person(s) to be insured with any external entity other than regulatory and
statutory bodies, as may be required and I will not hold the Company or its agents liable for use/sharing of this information.
h. I/We agree and undertake to convey to the Company any change/alterations carried out in the risk proposed for insurance after submission of this proposal form.
i. I/We consent to receive information from the Company the through physical, electronic or telecommunication means from time to time.

the undersigned hereby declare on my behalf and on behalf of each of the persons proposed to be insured that the above statements and particulars are true, accurate and
complete and correct in all respects and that there is all information which is relevant to this proposal that has been disclosed and not withheld from the Company. I declare
that the money used to make the premium payment has not been derived from any illegal activity or unaccounted funds. I further declare and agree that this declaration and
the answers given above shall be held to be promissory and shall be the basis of the contract between me/us and the Company.

You also agreed to receive service SMS and E-mail alerts.

Signature Not
Verified
Digitally signed by
MANISH DODEJA
Date: 2020.03.05
03:53:09 IST
Reason: I'm the author
Location: India

Religare Health Insurance Company Limited

Correspondence address : Unit no 604 - 607, 6th Floor, Tower C, Unitech Cyber Park, Sector 39, Gurgaon -122001.(HARYANA)
Website : www.religarehealthinsurance.com E-mail : customerfirst@religarehealthinsurance.com Call Us : 1800-102-4488