Date : 07 Oct 2024

Mr Pujari Gadilinganagouda
House No 219 Ward No 01
Near School Dammuru Bellary
583116
Bellary 583116
Karnataka
State Code : 29

Policy No: 90700581

Mobile No: XXXXXX0335

Dear Mr Pujari Gadilinganagouda,

Thank You for trusting us as your preferred Health Insurer.

At Care Health insurance, it is our endeavor to make quality healthcare easily accessible for our customers as well as ensure a truly hassle-free claim
servicing experience

To help you understand our services better, please go through the 'Know your policy better' kit that accompanies this
letter and constitutes the following

l Policy certificate
l Premium Acknowledgement

l Key Policy Information

l Claim Process - http://bit.ly/3EyPRnT
l Policy Terms and Conditions- https://bitly.cx/Nzbz and also available on Customer App

Also appended herewith for your convenience is your Care Health Card. This card should be presented at the time of an emergency or a planned
hospitalization, to avail cashless treatment at our network of over 16000+ cashless network pan-India.

To further simplify procedures, we're online as well. Visit our portal www.careinsurance.com and view network hospitals across the country, cashless
procedures and do much more.

For any assistance, please feel free to write to us at https://www.careinsurance.com/contact-us.html.

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

Team Care Health Insurance

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Policy Certificate Policy No. 90700581
Mr Pujari Gadilinganagouda Plan Name Care Supreme
House No 219 Ward No 01 Cover Type Floater
Near School Dammuru Bellary Policy Period - Start Date 00:00 hrs 13-Nov-2024
583116
Policy Period - End Date Midnight 12-Nov-2025
Bellary 583116
Karnataka Nominee Name (Relation) PUJARI JYOTHI (Wife)
State Code : 29 Premium Paid Rs.21,097.00
( Premium Rs 17879.09 + Underwriting Loading
Rs. 0.00 + CGST Rs. 0.00 + IGST Rs. 3,218.30 +
SGST/UGST Rs. 0.00 )
Premium Payment Mode Single Premium

Communication Address
Zone 2
Zone

Policyholder Gender Date Of Birth Client ID

Mr Pujari Gadilinganagouda Male 01-Jun-1984 C8396400

Details of Insured Person

Date of Birth Pre-existing diseases Insured with the

Name Client ID Relationship Sum Insured
(DD-MM-YYYY) (since) Company (since)
Pujari
C8396400 MEMBER 01-Jun-1984 NONE 13-Nov-2024 10,00,000.00
Gadilinganagouda
Pujari Preetam C8613974 SON 11-Mar-2014 NONE 13-Nov-2024
Aadhya Pujari C8613975 DAUGHTER 14-Feb-2017 NONE 13-Nov-2024
Pujari Jyothi C8613976 SPOUSE 06-Jun-1994 NONE 13-Nov-2024

Contact details for Claims & Policy Servicing

Care Health Insurance Limited, Vipul Tech Square, Tower C, 3rd Floor, Golf Course Road, Sector-43,
Correspondence address
Gurugram-122009 (Haryana)
E-mail ID for Claims claims@careinsurance.com
Website www.careinsurance.com

Intermediary Details

Name Code Contact Details

MADDALI SATYA PRASAD 20082055 9848452232

Schedule of Benefits

S No. Particulars Basis of Offering

1 Sum Insured 1000000

2 In-Patient Care Up to SI
3 Day Care Treatment All Day Care Procedures
4 Advance Technology Methods Up to SI
Up to SI, Pre-Hospitalization expense cover for 60 days prior to
5 Pre-Hospitalization Medical Expenses
hospitalization
Up to SI, Post-Hospitalization expense cover for 180 days after
6 Post Hospitalization Medical Expenses
discharge
7 AYUSH Treatment Up to SI
8 Domiciliary Hospitalization / Organ Donor Cover Up to SI
Schedule of Benefits

9 Ambulance Cover Up to Rs. 10,000

10 Cumulative Bonus 50% of SI, max up to 100% of SI.
11 Unlimited Automatic Recharge Available for unlimited times for unrelated or same illness.
12 Unlimited E-Consultations Available for Consultations with General Physicians
13 Health Services (Health Portal) Doctor on chat, Healthy tips reminder, etc.
Discounts on services such as consultations, diagnostics etc at our
14 Health Services (Discount Connect)
network
15 Room Rent / ICU All categories covered. / No Limit
16 Named Ailments Coverage 24 Months
17 Pre-existing Diseases Coverage 36 Months
18 Initial Wait Period 30 Days
19 Organ Donor Cover Up to SI

Optional Cover

S NO. Particulars Details

1 Annual Health check up Once for all Insured every policy year
Upto 100% increase in the Sum Insured, on a cumulative basis for
2 Cumulative Bonus Super
each completed and continuous policy year upto a max of 500%
Discount on renewal premium based on active days achieved.
3 Wellness Benefit Online fitness Coaching/Counselling session from Wellness
Coaches
4 Air Ambulance Cover Up to 5 lacs per year.
5 Claim Shield Coverage of specified 68 Non Payable Items as defined in T&C

Portability Details of the Insured

Previous Insurer : Aditya Birla Health

1st Enrollment Expiry Policy SI Rs.

Name First Policy Number Expiry Policy Number
Date (Original SI+CB)

PUJARI GADILINGANAGOUDA 21-22-377600 21-22-3776006-01 09-Nov-2022 5,00,000 + 2,50,000

PUJARI PREETAM 21-22-377600 21-22-3776006-01 09-Nov-2022 5,00,000 + 2,50,000
AADHYA PUJARI 21-22-377600 21-22-3776006-01 09-Nov-2022 5,00,000 + 2,50,000
PUJARI JYOTHI 21-22-377600 21-22-3776006-01 09-Nov-2022 5,00,000 + 2,50,000

Name Continuity Benefit approved by Company

Named Ailment Wait Period Pre-Existing Disease wait period

Continuity benefit available for Coverage PED wait Period reduced to 1 year for coverage
PUJARI GADILINGANAGOUDA
amount upto Rs. 7,50,000.00 in 0 year amount upto Rs. 7,50,000.00
Continuity benefit available for Coverage PED wait Period reduced to 1 year for coverage
PUJARI PREETAM
amount upto Rs. 7,50,000.00 in 0 year amount upto Rs. 7,50,000.00
Continuity benefit available for Coverage PED wait Period reduced to 1 year for coverage
AADHYA PUJARI
amount upto Rs. 7,50,000.00 in 0 year amount upto Rs. 7,50,000.00
Continuity benefit available for Coverage PED wait Period reduced to 1 year for coverage
PUJARI JYOTHI
amount upto Rs. 7,50,000.00 in 0 year amount upto Rs. 7,50,000.00
For Care Health Insurance Limited

Authorized Signatory
Date of Issue : 07 Oct 2024
Place of Issue : Gurgaon, Haryana
Service Branch : 4th Floor JM 2 401139Mohiuddin Estate Bandar road Vijayawada Andhra Branch Contact No. : 9289454736
Pradesh 520010Vijayawada,Andhra Pradesh,520010

Consolidated Stamp Duty paide vide E-Challan GRN No. 0117751470 dated 13/06/2024. RCM Applicability - N/A
SAC: 997133 and Description of Service: Accident and Health Insurance Services State
GSTIN No.: 37AADCR6281N1ZR
UIN :CHIHLIP23128V012223

Note:
- Attached with this Policy Certificate are the Policy terms and conditions, Optional Covers (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 feel free to write
to us at https://www.careinsurance.com/contact-us.html
- For waiting periods and exclusions under this Policy, please refer to Clause 4 of the Policy terms and conditions.
- This Policy Certificate in original must be surrendered to the Company in case of cancellation of the Policy.
Premium Acknowledgement

Policy No. 90700581

Client ID C8396400
Policyholder Mr Pujari Gadilinganagouda
House No 219 Ward No 01
Near School Dammuru Bellary
Address 583116
Bellary 583116
Karnataka

Policy Period 13-Nov-2024 to 12-Nov-2025

Premium Details

Particulars Amount (in Rs.) S.No. Receipt Number Amount Mode of Payment
1 B4382894 21,097.00 IPG
Gross Premium
Care Supreme 14,270.12

Annual Health Checkup(Supreme) 899.83

Cumulative Bonus Super 1,427.00
Wellness Benefit (Supreme) 64.86
Air Ambulance Cover (Supreme) 432.44
Claim Shield 784.84

Goods & Services Tax (GST) 3,218.30

Total 21,097.00

The Premium is rounded off to the nearest rupee.

Eligibility of Premium for Deduction u/s 80D of the Income Tax Act, 1961

The premium paid through any mode other than cash for this policy is eligible for Income tax benefits to the person making the payment
subject to the provisions of section 80D of the Income Tax Act, 1961 and amendments thereof. Effective from Assessment year 2019-20, in
cases where health insurance premium for multiple years is paid in one year, it will be eligible for proportionate deduction in the years in
which the health insurance continues to be effective.

For Care Health Insurance Limited Signature Not Verified

Digitally signed by Manish Dodeja
Date: 20241007140352
Reason: I'm the author
Location: India

Authorized Signatory

Date of Issue : 07 Oct 2024

Place of Issue : Gurgaon, Haryana

Note:
1) In case of any discrepancy, the Policyholder is requested to contact the Company immediately.
2) Any amount paid in cash towards the premium would not qualify for tax benefits as mentioned above.
3) 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.
4) This Policy is issued subject to realization of the premium amount. In case the instrument given towards the premium amount is
dishonored, then the cover provided under this Policy shall automatically get cancelled. In the given scenario, if any amount has been
paid by the Company in respect of a claim or due to any other reason than the amount so advanced by the Company shall be
refunded to the Company forthwith.
5) We may credit upto Rs. 1/- to your account for validation, before remitting any further payment.
Proposal Form-'CARE SUPREME'
Dear Mr Pujari Gadilinganagouda
In reference to your online proposal (1120086722943) for 'Care Supreme'- Comprehensive Health Insurance policy, please find below the
details as provided by you:

Proposer Details
Name : Mr Pujari Gadilinganagouda
Address : House No 219 Ward No 01
Near School Dammuru Bellary
Bellary 583116,Karnataka
583116
Date of Birth : 01-Jun-1984

Landline :
Mobile : XXXXXX0335
E-mail : gXXXXXXa@gmail.com

Details of the Persons be Insured

Name Date of Birth Relation Pre-existing Diseases

Pujari Gadilinganagouda 01-Jun-1984 MEMBER NONE

Pujari Preetam 11-Mar-2014 SON NONE
Aadhya Pujari 14-Feb-2017 DAUGHTER NONE
Pujari Jyothi 06-Jun-1994 SPOUSE NONE

Additional Details

1. Does any person(s) to be insured has any pre-existing diseases?

Insured1 Insured2 Insured3 Insured4

N N N N

2. Have any of the person(s) to be insured ever filed a claim with their current / previous insurer?

Insured1 Insured2 Insured3 Insured4

N N N N
Has any of your proposal(s) for Health insurance been declined, cancelled, charged a higher premium or issued with
3.
special condition(s)?
Insured1 Insured2 Insured3 Insured4

N N N N

4. Is any of the person(s) proposed for insurance covered under any other health insurance policy with the Company?

Insured1 Insured2 Insured3 Insured4

N N N N
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/online, 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 hereby declare that the lives proposed to be insured would submit to medical examinations before the nominated doctors of the
Company or undergo diagnostic or other medical tests, as suggested by the Company for its underwriting.

f. 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.

g. 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.

i. 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.

j. 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, complete and correct in all respects and that all information which is relevant to this proposal 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.

By virtue of this communication, I give my implicit approval on receiving Whatsapp, SMS, E-mail (Transactional & promotional) from
the company.

The details mentioned in above proposal form have been verified through OTP received on my registered mobile number.
No physical Health Cards will be dispatched. The electronic version of the card below will be accepted across all network providers.

www.careinsurance.com
Policy No.
90700581

Member ID DOB NAME

C8396400 01-Jun-1984 Pujari Gadilinganagouda
C8613974 11-Mar-2014 Pujari Preetam
C8613975 14-Feb-2017 Aadhya Pujari Submit Your Queries/Requests: www.careinsurance.com/contact-us.html
C8613976 06-Jun-1994 Pujari Jyothi Disclaimer
1. This card is not transferable
2. Use of this card is governed by the policy terms &
conditions
3. To avail cashless facility.this card needs to be produced along with photo
ID Valid
4. proofupto policy period end date or cancellation date,whichever is earlier
IRDAI Registration No.148