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Date : 10 February 2022

Mr Pothula Bhavani Chandra Sekhar

Door No.7-1-23/4,Durgamma Vari Street,Narasaiah
Agraharam,Bhimavaram,West Godavari(Dt)
Bhimavaram
Bhimavaram 534201
Andhra Pradesh
Policy No. : 38486346
Mobile No. : XXXXXX3506

Dear Mr Pothula Bhavani Chandra Sekhar,

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:

Policy Certificate

Premium Acknowledgement

Key Policy Information

Claim Process

Policy Terms and Conditions- https://bit.ly/3qaIs5e 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 d o much more. In case of
a query at any juncture, feel free to mail us at customerfirst@careinsurance.com or call us at 1800-102-4488.

For any assistance feel free to mail us at customerfirst@careinsurance.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

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 CUSTOMER APP

For Android For iOS

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Policy Certificate Policy No. 38486346

Plan Name CARE PLUS
Mr Pothula Bhavani Chandra Sekhar Cover type Individual
Door No.7-1-23/4,Durgamma Vari Street,Narasaiah Policy Period - Start Date 00:00 hrs 11-Feb-2022
Policy Period - End Date Midnight 10-Feb-2023
Agraharam,Bhimavaram,West Godavari(Dt) Nominee Name Pothula Venkata Nageswara Rao
Nominee Relationship (Father)
Bhimavaram Premium Paid Rs. 8585
(Premium Rs 7275.2 + CGST Rs 0 + IGST Rs 1309.54 + SGST Rs 0
+ UGST Rs 0)
Bhimavaram 534201
Premium Payment Mode Single Premium
Andhra Pradesh 37

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Policyholder Gender Date Of Birth Client ID

Pothula Bhavani Chandra Sekhar Male 29-May-1995 32213474

Details of Insured
Date of Birth Insured with the Sum Insured
Name Client ID Relationship (DD-MM-YYYY) Pre-existing diseases (since) Company (since)
Pothula Bhavani Chandra Sekhar 32213474 Member 29-May-1995 None 11-Feb-2022 5,00,000.00

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Contact details for Claims & Policy Servicing
Care Health Insurance Limited
(Formerly known as Religare Health Insurance Company Limited)
Correspondence address Unit no 604 - 607, 6th Floor, Tower C, Unitech Cyber Park,
Sector 39, Gurgaon -122001.(HARYANA)

Contact no. 1800-102-4488

Fax no. 1800-200-6677

E-mail ID for Claims claims@careinsurance.com

E-mail ID for Policy servicing customerfirst@careinsurance.com

Website www.careinsurance.com

Intermediary Details
Name Code Contact Number

Care Health Insurance Ltd. Direct 1800-102-6655

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Schedule of Benefits
S No. Particulars Basis of Offering
1 Hospitalization Expenses (Conditions for Medical Expenses) Upto Rs.5,00,000

2 Pre-hospitalisation & Post-hospitalization Expenses Pre-hospitalization upto 60 days; Post-hospitalization upto 90 days

3 Ambulance Cover Upto Rs. 2000 per hospitalization

4 Organ Donor Cover Upto SI

5 Domiciliary Hospitalization Upto SI

6 Second Opinion Once in a policy year (per member)

7 Annual Health-Check Up Available for adult members

8 Unlimited Automatic Recharge Up to SI (unlimited times, applicable for same illness as well)

9 AYUSH Treatments 10% of SI

10 Air Ambulance Cover Up to SI or maximum of 5 Lacs per policy year, whichever is lower

50% increase in SI per Policy Year,max upto 200% SI. No reduction in

11 No Claim Bonus Protect NCB, if total claim amount <25% of SI in a policy year

Accidental Death -100% of SI Permanent Total Disablement - Up to

12 Personal Accident Cover (AD & PTD) 100% of SI

The base policy SI will be increased on cumulative basis at each renewal

13 Inflation Shield onthe basis of inflation rate in previous year.

14 Unlimited E-Consultation Available for General Physicians

Wellness program that allows the customer to Earn and Burn the
15 Earn and Burn reward points.

16 Health Services Health Portal and Discount Connect

17 Pre-Existing Diseases 36 Months

18 Out-patient Consultations Up to Rs.1,500, Limit per consultation is Rs.350/-

19 Out-patient Dental and Ophthalmic Treatments Up to Rs.1,500

20 Room Rent Single Private Room

21 ICU Charges No Limits

22 Initial Wait Period 30 Days, except for accidents

23 Named Ailment 24 Months

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For Care Health Insurance Limited
(Formerly known as Religare Health Insurance Company Limited)

Authorized Signatory Date of Issue : 10-Feb-2022 Place of Issue : Gurgaon, Haryana

Service Branch : CHIL, Rosy Towers, R S No. 146 Part Old No3 New Door No 7, Nungambakkam High Road, Chennai, Tamil Nadu - 600034 Branch Contact No. : 1800-102-4488
Correspondence Address:
Care Health Insurance Limited
(Formerly known as Religare Health Insurance Company Limited)
Unit no 604 - 607, 6th Floor, Tower C, Unitech Cyber Park,
Website : www.careinsurance.com Email : customerfirst@careinsurance.com
Consolidated Stamp Duty paid vide E-Challan GRN no. 84404086 dated 23 November 2021, RCM Applicability- N/A
SAC: 997133 and Description of Service: Accident and Health Insurance Services State GSTIN No.: 33AADCR6281N1ZZ IRDA Registration Number - 148 UIN : CHIHLIP22047V012122
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 and conditions, Optional Covers (if opted) and Annexures. Please ensure that these documents have been received, ead and understood. If any of these
documents have not been received, please email at customerfirst@careinsurance.com or contact the Company at 1800-102-4488 / 1800-102-6655.
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.
NB
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Premium Acknowledgement

Policy No. 38486346

Client ID 32213474
Policyholder Mr Pothula Bhavani Chandra Sekhar
Address Door No.7-1-23/4,Durgamma Vari Street,Narasaiah
Agraharam,Bhimavaram,West Godavari(Dt)
Bhimavaram
Bhimavaram 534201, Andhra Pradesh
Policy Period 11-Feb-2022 to 10-Feb-2023

Premium Details
Particulars Amount (in Rs.) S.no. Receipt Number Amount Mode of Payment
1 37803915 8585 INTERNET PAYMENT GATEWAY (IPG)
Gross Premium
Care Plus 7,275.20

Goods & Services Tax (GST) 1,309.54

Total 8,585.00

The Premium is rounded off to the nearest rupee.

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

This is to certify that Care Health Insurance Ltd. (Formerly known as Religare Health Insurance Company Limited) has received an
amount of Rs. 8,585.00/- from Mr Pothula Bhavani Chandra Sekhar towards Payment of Health insurance premium as per the details
mentioned above. The premium paid for this policy is eligible for applicable tax benefits u/s 80D of the Income Tax Act, 1961 and
amendments thereof.

For Care Health Insurance Limited

(Formerly known as Religare Health Insurance Company Limited)

Authorized Signatory Date of Issue: 10-Feb-2022 Place of Issue: Gurgaon, Haryana

IRDA Registration Number - 148

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) 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.
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Proposal Form-'CARE'

Dear Mr Pothula Bhavani Chandra Sekhar

In reference to your online proposal (1120030882480) for 'Care'- Comprehensive Health Insurance policy, please find below the details as provided
by you:

Proposer Details

Name : MR POTHULA BHAVANI CHANDRA SEKHAR

Address : Door No.7-1-23/4,Durgamma Vari Street,Narasaiah

Agraharam,Bhimavaram,West Godavari(Dt)
Bhimavaram
Bhimavaram-534201
Andhra Pradesh

Date of Birth : 29/05/95

Landline :

Mobile : XXXXXX3506

E-mail : divinedevils786@gmail.com

Details of the Persons be Insured

Name Date of Birth Relation Pre-existing Diseases

POTHULA BHAVANI CHANDRA SEKHAR 29/05/95 MEMBER NONE

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

Insured 1
No
B. Have any of the person(s) to be insured ever filed a claim with their current/previous insurer?

Insured 1
No

C. Has any proposal for Health insurance been declined, cancelled or charged a higher premium?

Insured 1
No

D. Is any of the person(s) to be insured, already covered under any other health insurance policy of Care Health Insurance?

Insured 1
No
E. Does your job require you to be involved with any hazardous activity, significant manual labor, operating heavy machinery, handling hazardous
material, working at heights / underground / construction sites, oil rigging, high voltage, high temperature, working in aircrafts or sea-going vessels or
adventure sports or armed forces?
Insured 1
No
 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 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.

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, 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.

The details mentioned in above proposal form has been verified through OTP N
38486346

32213474 29-May-1995 Pothula Bhavani Chandra Sekhar

Signature Not
Verified
Digitally signed by
MANISH DODEJA
Date: 2022.02.10
10:31:10 IST
Reason: I'm the author
Location: India