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    Star Health PolicySofyCopy - 30625

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    vipin jain

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    Star Health PolicySofyCopy - 30625

    Uploaded by

    vipin jain
    11 views4 pages

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    Star Health PolicySofyCopy_30625

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    11 views4 pages

    Star Health PolicySofyCopy - 30625

    Uploaded by

    vipin jain

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    You are on page 1of 4

    Family Health Optima Insurance Plan

    Unique Identification No.IRDA/NL-HLT/SHAI/P-H/V.II/129/14-15


    Policy Schedule
    Policy No. : P/161117/01/2016/009389 Previous Policy No. : 900001/11052/AA00197379
    Customer Code : AA0003278925 Issuing Office Code : 161117
    Customer Name : VIPIN JAIN Issuing Office Name : Branch Office - Gurgaon
    Proposer's Code : 5014095
    Proposer's Name : VIPIN JAIN
    Address : A-4 SOUTH WEST BLOCK, Address : 8th Floor, Palm Court
    NEAR SUNIL NURSINGH HOME, Maharana Pratap Circle, Gurgaon
    ALWAR - RAJASTHAN - 122001
    Alwar (M Cl+OG),Alwar,Rajasthan-
    301001
    Phone No : NIL/9587009808/ Phone No : 0124-4797454, 55, 56
    E-mail id : JAINVIPIN@GMAIL.COM E-mail id : gurgaon@starhealth.in
    Proposal date : 19/02/2016 Fulfiller Code : SH22454
    Date of Inception of first policy : 26-FEB-16
    Renewal Year : NEW
    Intermediary Code : WA0000000009
    Receipt No : 1134010384 :
    Name M/S.Policy Bazaar Insurance
    Receipt Date : 19/02/2016
    Web Aggregator Pvt Ltd
    Premium : Rs 5765 /- Service Tax : Rs 836 /-
    Phone No : 0/9717567744
    Stamp Duty : Re 1 /- Total Premium : Rs 6601 /-

    E-mail id : crthealth@policybazaar.com
    Total Premium In Words : Rupees Six Thousand Six Hundred One Only
    PERIOD OF INSURANCE FROM : 26/02/2016 14:21:00 TO : Midnight Of 25/02/2017
    SCHEME - DESCRIPTION : 2 ADULTS BASIC FLOATER SUM INSURED : Rs. 500000
    In Words: Five Lakhs Only
    Bonus : Rs 0
    .
    Limit of coverage : Rs. 500000 Recharge Benefit : 150000

    Details of Insured Persons :

    Sl. Name of the Insured Sex Date of Birth Age- Relationship with ID Card No Pre Existing Disease/s
    No. Yrs/Mths Proposer
    1 VIPIN JAIN M 11/08/1984 31 Yrs SELF 5014095-1 No PED declared
    6 Mths

    2 SWETA JAIN F 13/08/1989 26 Yrs SPOUSE 5014095-2 No PED declared


    6 Mths

    Please check whether the details given by you about the insured persons in the proposal form are incorporated correctly in the policy
    schedule. If you find any discrepancy, please inform us within 15 days from the date of receipt of the policy, failing which the details relating
    to the insured person given in the policy schedule are deemed to have been accepted by you.
    Warranted that in case of dishonor of premium cheque(s), the Company shall not be liable under the policy and the policy shall be void abinitio
    (from inception).
    Expenses relating to the hospitalisation will be considered in proportion to the room rent stated in the policy.
    THE INSURANCE UNDER THIS POLICY IS SUBJECT TO CONDITIONS, CLAUSES, WARRANTIES, EXCLUSIONS ETC., ATTACHED.
    Important
    In the event of hospitalization of insured person, intimation should be given to the Company immediately, however, within 24 hrs from the time
    of admission.
    Sector Classification

    Urban

    Entered By : SH26660 For Star Health and Allied Insurance Company Ltd.
    IRDAI Regn. No 129
    Corporate Identity Number U66010TN2005PLC056649
    Email ID : info@starhealth.in Authorised Signatory
    1 of 4
    Attached to and forming part of Policy No. P/161117/01/2016/009389
    Toll Free No : 1800 425 2255 Email: support@starhealth.in, Fax No: 1800 425 5522.
    Nominee Details:

    Insured Name: VIPIN JAIN

    Sr. Nominee Relationship Percentage Appointee Appointee Appointee


    Nominee Name Age
    No Name Age Relationship

    Insured Name: SWETA JAIN

    Sr. Nominee Relationship Percentage Appointee Appointee Appointee


    Nominee Name Age
    No Name Age Relationship

    In witness whereof the undersigned being authorized by and on behalf of the company has set his hand at Branch Office - Gurgaon on
    19th Day of February 2016.

    Entered By : SH26660 For Star Health and Allied Insurance Company Ltd.

    Authorised Signatory
    2 of 4
    Attached to and forming part of Policy No. P/161117/01/2016/009389

    Attached to and forming part of Policy No : P/161117/01/2016/009389

    Continuity Benefits applicable is as follows

    30 Days First Two Year


    S.No. Name Id. No 1st Year Pre Existing Disease
    Waiting Period Exclusion
    Exclusions

    1 VIPIN JAIN 5014095-1 Waived Waived Not Waived Not Covered

    2 SWETA JAIN 5014095-2 Waived Waived Not Waived Not Covered

    Entered By : SH26660 For Star Health and Allied Insurance Company Ltd.

    Authorised Signatory
    3 of 4
    Star Health and Allied Insurance
    Company Limited

    Emergency Help Line No. 1800 425 2255 / 044 - 2831 9100 Customer Identity Card
    e-mail : support@starhealth.in Website : www.starhealth.in Customer ID No. : 5014095-1
    Please quote the Customer Id No. for assistance
    Name : VIPIN JAIN
    This Card is valid until otherwise Cancelled Date Of Birth : 11-AUG-84 Age : 31 Years
    This ID Card is invalid, if the insurance cover is not in force
    Gender : Male Office Code : 161117
    Immediate intimation to 'Star' through above Tel Nos. is a must
    in case of Hospitalisation. Valid From : 26-FEB-16 SSM/SM Code : SH22454
    Agent/Broker/MT Code : WA0000000009
    For Free Medical Advice Call TOLL FREE 1800 425 2255 Personal and Caring

    Star Health and Allied Insurance


    Company Limited
    Customer Identity Card

    Customer ID No. : 5014095-2


    Name : SWETA JAIN
    Date Of Birth : 13-AUG-89 Age : 26 Years
    Gender : Female Office Code : 161117
    Valid From : 26-FEB-16 SSM/SM Code : SH22454
    Agent/Broker/MT Code : WA0000000009
    Personal and Caring

    Entered By : SH26660 For Star Health and Allied Insurance Company Ltd.

    Authorised Signatory
    4 of 4

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