Scribd
Upload
85 views3 pages

Surya PDF

Uploaded by

Besan Ladu
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
85 views3 pages

Surya PDF

Uploaded by

Besan Ladu
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 3

COPY

Tax Gain - Health Advantage Plus


PREAMBLE:ICICI Lombard General Insurance Company Limited ("the Company"), having received a proposal and the premium from the
proposer named in the Schedule referred to herein below, and the said Proposal, Declaration and Annexure thereto together with any
statement, report or other document leading to the issue of this Policy and referred to therein having been accepted and agreed to by the
Company and the Proposer as the basis of this contract do, by this policy agree, in consideration of and subject to the due receipt of the
subsequent premiums, as set out in the schedule with all its parts, and further, subject to the terms and conditions contained in this policy, as
set out in the schedule with all its parts, that in proof to the satisfaction of the Company of the compensation having become payable as set
out in Part I of the schedule to the title Policy, the Sum Insured/appropriate benefit will be paid by the Company.
Part I Of Schedule
Details of Policy Holder/ Proposer:
Policy No 4063/HAP/03386781/00/000
Name of the Proposer JAYSHEEL VINOD SHARMA
Correspondence Address SUNSHREE WOODS FLOT NO 603 BLDG-A KOMDNWA NIBM ROAD
City PUNE - 411048
State MAHARASHTRA
Contact No(s) Mobile No 9890880750
Period of Insurance From 00:00 hrs 14-Mar-2008 to Midnight of 13-Mar-2009
Email Address
Details of Family Members covered under the Policy :
Benefit
Age Benefit A
B
Name of the Insured(s) Gender Relation Pre-Existing illness/injury Health Member ID No. Plan Name
Year Months Hospitalization OPD
SHOBHANA Macular rashes/petechiae present IHPN-
56 7 F MOTHER 200000 4500 Individual
SHARMA on b/l legs, Eosinophilia 03538319/01

Year 1
Plan Name Total Premium (Rs.)
Basic Premium (Rs.) Service Tax (Rs.) Education Cess (Rs.) Secondary and Higher Education Cess (Rs.)
Individual 13349.95 1601.99 32.04 16.02 15000

For ICICI LOMBARD GENERAL INSURANCE


The stamp duty of Rs.1 (One Only) COMPANY LIMITED
paid in cash or by demand draft or
by pay order,vide Receipt/Challan
no.14299 dated 20-Jul-2007
Date of Issue: 07-Apr-2008
Location: Mumbai Authorized Signatory
Service Tax Reg. No.: GIS/MUMBAI-
I/1528/2001
Service Tax Code Number -
AACI7904GST001
Important Note : This schedule and the attached policy shall be read together as one contract or any word or expression to which a specific
meaning has been attached in any part of this policy or of the schedule shall bear the same meaning wherever it may appear.
IMPORTANT :Insurance benefit shall become voidable at the option of the Company, in the event of any untrue or incorrect statement,
misrepresentation, non description or non-disclosure of any material particular in the Proposal Form/ personal statement, declaration and
connected documents, or any material information has been withheld by beneficiary or anyone acting on beneficiary's behalf to obtain
insurance benefit. Please note that any claims arising out of pre-existing illness/injury/symptoms is excluded from the scope of this policy
subject to applicable terms and conditions. Refer to attached Part II and III of the schedule for the terms and conditions.All disputes are
subject to the jurisdiction of Mumbai High Court only.
Kindly acknowledge receipt of this policy. Incase you find any variations against your proposal or any discrepancy in the policy,
contact us immediately.
Premium Certificate
For the purpose of deduction under section 80D of Income Tax amendment act, 1961 and any amendments made thereafter.
To,
JAYSHEEL VINOD SHARMA
This is to certify that an amount of Rs 15000 has been received by the Company towards premium
for the health policy no : 4063/HAP/03386781/00/000 issued to JAYSHEEL VINOD SHARMA for a period from 07-Mar-2008 to 13-Mar-
2009 .
Financial Year
2007 - 2008 15000
(Rs.) For ICICI Lombard General
Insurance Co. Ltd.
Total Premium
15000
(Rs.)
Collection No: 844883
Authorized Signatory
Collection Date 07-Mar-2008
Issuing office Mumbai
Note:
l This certificate must be surrendered to the Insurance Company in case of Cancellation of the policy. In the event of incorrect
representation of this declaration, the liability shall be upon the policyholder.
l For the purpose of deduction under section 80D, the benefit shall be as per the provisions of the Income Tax Act, 1961 and any
Amendments made thereafter.

Claim Procedure
Before going to the hospital please call TTK Health Care Services for complete assistance & guidance
TTK Health Care Services Helpline Numbers
1800-425-8854 022-23012590
1800-425-8885 080-25203771
Web Site: www.
Email:care@ttkhealthcareservices.com
ttkhealthcareservices.com
Emergency or planned hospitalization
Simply use your Health ID card at TTK's network hospitals (Refer www.icicilombard.com for updated list) and avail of cashless
service. Call TTK's 24-hour-toll-free number 1800-425-8885/7878/8854 for claims registration.
Treatment in non-network hospitals
The claim form (available at www.icicilombard.com) must be filled fully after discharge from hospital and sent to TTK office along
with the following documents in original.
l Hospital Bill with Receipt for payment, the receipt should be stamped and preferably numbered.
l Doctors prescription and medicine bills.
l Discharge summary from the hospital.
l Pathological reports and other investigation reports along with the doctor's authorization.
l All other relevant details and documents connected to hospitalization.

Note: Please refer to the policy wordings for complete information on Coverage & Exclusions.
For more information on our product, Log on to
E-Mail ID : customersupport@icicilombard.com
www.icicilombard.com
Name : SHOBHANA SHARMA

Policy No. : 4063/HAP/03386781/00/000

Card No. : IHPN-03538319/01

Gender : Female Age : 56 Dob : 12-Aug-1951

Valid Upto : 13-Mar-2009

You might also like