HDFC ERGO General Insurance Company Limited

2952203752935402000

Mr Abhinav Walia
G-1 Gopal Nagar Azadpur L G Showroom . North
West Delhi, 110033
Delhi
Contact No : 98XXXXXXX1

Date : 20/11/2023

Dear Mr Abhinav Walia

Thank you for choosing HDFC ERGO as your preferred insurance partner. We welcome you to be a part of our family !
Your Health insurance policy reference no 2952203752935402000 is confirmed on the basis of the information and declaration given by you.
The details of coverage are mentioned in the enclosed policy schedule of insurance.

As a measure of our customer convenience we have implemented a Lifetime Validity Health Card. For you, this simply means that your Health Card is valid for all subsequent
renewals and as long as your policy is active with us. Hence, you need not replace your health card every year

We value your relationship with us and assure you our best services at all times and we look forward to serve you.

Now you can view your policy details and health card at your fingertips. Download our Mobile App now and experience convenience today!!
Proposer details have been updated basis the information present in the KYC documents. If you find any detail which needs to be corrected, request you to create/ modify the
eKYC ID and place a request for endorsement.

Soft copy of the policy is valid for all purposes including claims.

For HDFC ERGO General Insurance Company Ltd.

Arun Sharma
Head - Customer Experience Management

HDFC ERGO General Insurance Company Limited 2952203752935402000

TAX CERTIFICATE

Dear MR ABHINAV WALIA

Subject : Certificate for the purpose of deduction under section 80 D of Income Tax Act, 1961

This i s to certify that we have received an amount of ` 14875 towards premium for my: health Suraksha Policy , Policy No. 2952203752935402000 issued to for
the period 17/11/2023 to 16/11/2024.

Note : This is subject to the provisions of Section 80D of income tax Act, 1961 as amended from time to time.

For HDFC ERGO General Insurance Company Ltd.

Date : 20/11/2023

Policy Issuing Office: Mumbai

Duly Constituted Attorney

HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN: HDFHLIP24079V072324. Customer Service Address: D 301, 3rd Floor,
CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078.
165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service No : +91 22-62346234/+91-120 6234 6234 | www.hdfcergo.com
HDFC ERGO General Insurance Company Limited
POLICY SCHEDULE my: health Suraksha Policy

2952203752935402000

Policy No. :2952 2037 5293 5402 000 Issuance Date :20/11/2023
Period of Insurance :From 17/11/2023 19:45 hrs To 16/11/2024 Midnight
Invoice No. :203752935402000 Premium Frequency :Yearly
0

HSN Code :997133 Policy Type :Family Floater

Mr Abhinav Walia Proposer Name :Mr Abhinav Walia PAN :
G-1 Gopal Nagar AzadpurL G Showroom .North West Delhi
Customer Id :1019970268070001
Delhi, 110033, Contact No : 98XXXXXXX1

EIA No. : Not provided

Payment Details : 1002311178392 , Bank Name:HDFC Bank Ltd
Email ID : abxxxxxxxxxxxxxxxx88@gxxxx.com
Insured Person’s Details & Sum Insured
Insured's Name Relation with Gender DOB Nominee Name Nominee 1st Policy Basic Sum Tier CB Amount Pre
policy holder Relationship Inception Insured (`) (`) Existing
Disease
Abhinav Walia Self Male 09/09/1988 Neeru Walia Spouse 31/10/2020 300000 Tier 1 45000 NO
Neeru Walia Wife Female 26/03/1987 31/10/2020 NO
Mehar Walia Daughter Female 09/08/2021 31/10/2020 NO
Schedule of Coverage
Section Covers Details/ Applicability of Sum Insured Limit
A Hospitalization Cover up to Basic Sum Insured including cumulative Bonus Basic Sum Insured and CB
Medical Expenses Basic Sum Insured and CB
1B Mental Healthcare Basic Sum Insured and CB
2 Home Healthcare Basic Sum Insured and CB
3 Domiciliary Hospitalization Basic Sum Insured and CB
4 Pre-Hospitalization 60 Days
5 Post-Hospitalization 180 Days
6 Day Care Procedures Basic Sum Insured and CB
7 Road Ambulance cover Sub limited within the Basic Sum Insured including SI 1 to 5 L -2,000
Cumulative Bonus SI 6 to 50 L -3,500
SI Above 50 L -15,000
8 Organ Donor Expenses upto Basic Sum Insured including cumulative Bonus Basic Sum Insured and CB
9 Alternative Treatment upto Basic Sum Insured including cumulative Bonus Basic Sum Insured and CB
C1 Preventive Health Check Up -Booster over and above the Basic Sum Insured Covered Up to 1% of Basic Sum Insured max upto
Rs 5,000, on every renewal
C5 Recovery Benefit over and above the Basic Sum Insured 5000
C6 Sum Insured Rebound over and above the Basic Sum Insured Upto 100% of Basic Sum Insured
Renewal Benefits
1 Cumulative Bonus Applicable ( 5% of SI at each claim free yr, max 50% )
2 my:health Active Applicable
Waiting Periods
Sec E 1 i - General waiting period - 30 days from Policy inception date
Section A Hospitalization Cover Sec E 1 ii - Listed illness & procedures - 24 Months
Sec E 1 iii - Preexisting conditions - 48 Months
Premium Details (`)
Basic Premium 12,606.00
Loadings 0.00
GST 18% : Central Tax 9% ( `1134.5 ) + State Tax 9% ( `1134.5) 2,269.00
Total Premium 14,875.00
For Claim/Policy related queries call us at +91- 22 6234 6234/+91- 120 6234 6234 or Visit Help Section on www.hdfcergo.com for policy copy/tax certificate/make changes/register & track claim.
If the premium is not realised the policy shall be void from inception.The stamp duty of Rs. 1/- ( Rupees One And Zero Paise Only ) paid vide e-stamp Certificate No.(LOA/ENF-1/CSD/34/2023/ Validity Period
Dt. 28/12/2023 to Dt. 31/12/2026. OW No. 6045 Date 27/Dec/2023 GRN NO. MH011651000202324M Dt. 05/12/2023, SBI Bank & DEFACE No. 0006692260202324 Dt. 21/12/2023) dated 27/12/2023 as
prescribed in Government of Maharashtra Order No. Mudrank-2017/CR.97/M-1, dated the 09th January 2018". GST Registration No: 07AABCL5045N1ZA. GST for this invoice is not payable under reverse
charge basis. I/ We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the aggregate turnover notified under sub-rule (4) of rule 48, we are not
required to prepare an invoice in terms of the provisions of the said sub-rule
Branch :unit no. 209, 211 & 212 a, 2nd floor, plot no. 54 mahatta towers, community center, janakpuri west delhi Write to us : feedbackgeneral.insurance@in.hdfcbank.com
For HDFC ERGO General Insurance Company Ltd.
Agent Name :HDFC BANK LTD Agent Code :201587086428 Tel No. : 91-22-61606161

Duly Constituted Attorney

"For detailed policy terms and conditions please visit our website https://www.hdfcergo.com/download/policy-wordings."

HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN: HDFHLIP24079V072324. Customer Service Address: D 301, 3rd Floor,
CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078.
165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service No : +91 22-62346234/+91-120 6234 6234 | www.hdfcergo.com
HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited 3

Policy No.:2952203752935402000 This card is for identification purpose only.
Valid From: 17/11/2023 Renewal Date: 16 November
Card has to be presented to the Network Service Provider at the time of admission/ availing
Insured Name Member ID Date Of Birth Gender cashless hospitalization o r any other services. Insurance claim will be processed in accordance
Mehar WALIA 10010000 09/08/2021 Female with the policy term & conditions. Card does not guarantee cashless hospitalization or any other
NEERU WALIA 10010000 26/03/1987 Female service. For more details and updated list of Network Service Provider please refer our website or
ABHINAV WALIA 10010000 09/09/1988 Male call our call centre. This card is valid till the time policy is active.

Customer Service No : 022 - 6234 6234 / 0120 - 6234 6234

Fax Number : 022 - 6234 6234/0120 - 6234 6234
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. IRDAI Reg No.146 UIN: HDFHLIP24079V072324. Customer Service Address: D 301, 3rd Floor,
CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078.
165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service No : +91 22-62346234/+91-120 6234 6234 | www.hdfcergo.com