HDFC ERGO General Insurance Company Limited

2806203700409304000

Mr Kunal .
H No-1253 E-Block Ist Avenue 12Th
Floor Gaurcity-I Greater-Noida Greater
Noida Uttar Pradesh-201301
Contact No.: 9711102765

Policy No : 2806203700409304000

Intermediary Code Intermediary Name Intermediary Contact Number

201254637115 DILIP KUMAR 9891666426

Renewal of Your Easy Health Floater Standard Insurance Policy

Dear Mr Kunal . ,

Welcome to HDFC ERGO General Insurance Company Limited. We are pleased to issue you Renewal of Your Easy Health Floater Standard Insurance Policy.
We advise you to retain your Policy Kit during the entire term of the Policy (including renewals).

Please note that the Policy has been issued to you based on the declarations, details and documents received from/on behalf of you in/along with the Proposal
Form submitted to us.

Please visit our website www.hdfcergo.com for more information about our Company, Grievance handling and any other support. To know the updated list of our
network hospitals please visit http://www.hdfcergo.com/our-hospitals-network.aspx

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

Warm Regards,

Location: Mumbai
Authorized Signatory Date: 28/12/2023

Note:
1. Please update us with your latest contact details (in case of any change) so that same can be updated in our records.
2. You can either email us on care@hdfcergo.com or call on our Customer care no. 022 6234 6234 / 0120 6234 6234.
3. *The Copy of the proposal form has been sent on your registered email id if policy is purchased through website.

Certificate for the purpose of deduction under Section 80 D of Income Tax Act, 1961*
This is to certify that the Proposer KUNAL . has paid Rs.26605 (Rupees TWENTY-SIX THOUSAND SIX HUNDRED FIVE) towards premium for Policy No.
2806203700409304000 issued to MR KUNAL . for period 30-Dec-2023 to 29-Dec-2024.

For and on behalf of HDFC ERGO General Insurance Company Limited

Location: Mumbai
Date: 28/12/2023

Authorized Signatory
*Note

1. This is subject to the provisions of Section 80D of Income Tax Act, 1961 as amended from time to time.
2. This certificate must be surrendered to the company in case of cancellation of this policy. In event of incorrect representation of this declaration the
liability shall be upon the Policyholder.
3. Please note that this certificate will not be issued if the premium payment has been made in cash.
4. In case of dishonor of the premium instrument, the policy will be deemed cancelled ab initio.
5. 80D benefit is applicable for only Self, Spouse, Dependent Children and Dependent parents.

HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, 165/166 Backbay Reclamation, H.T.Parekh Marg,
Churchgate, Mumbai - 400 020. UIN: HDHHLIP21378V062021. Customer Service Address: D 301, 3rd Floor, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400078. Customer Service
No : +91 22-62346234 /+91-120 6234 6234 www.hdfcergo.com
 HDFC ERGO General Insurance Company Limited

Policy Schedule - Easy Health Floater Standard

Policy Number 2806 2037 0040 9304 000

Policy Holder’s Name Mr Kunal .
Policy Holder’s Address H No-1253 E-Block Ist Avenue 12Th Floor Gaurcity-I Greater-Noida Greater Noida Uttar Pradesh-201301
Policy Holder State Name & Code Uttar Pradesh & 09 Place of Supply UTTAR PRADESH
GSTIN/ UIN (if any) of Policy Holder
First policy inception date 29/12/2015 Policy Issuance Date 28/12/2023
Policy Period From 00:01 hrs on 30/12/2023 To 24:00 hrs on 29/12/2024
<b>Policy Issuing Office :</b> 1ST FLOOR, 2E/25, JHANDEWALAN EXTENSION, JHANDEWALAN, NEW DELHI -
Issuing/Servicing Office
110005 CENTRAL DELHI, 110005.
GSTIN 09AABCL5045N1Z6
Intermediary Name DILIP KUMAR Intermediary Contact No 9891666426
Intermediary Code 201254637115 Description/ Harmonized System Of Accident and Health insurance
Nomenclature Code Services/9971
Insured Person Details
Member 1 Member 2 Member 3 Member 4 Member 5 Member 6
KUNAL . / Mrs Shalini Sinha / Master Shorya
Particulars / Member ID
2020010001927892 2020010001927893 Samarth /
2020010001927894
Date of Birth (Age) 18/02/1981 (42) 05/01/1981 (42) 01/03/2014 (9) - - -
Relationship to Policy
Self Wife Son - - -
Holder
Base Sum Insured (`) 1000000
Cumulative Bonus (`) 450000
Protector Rider
-
Sum Insured (`)
Total Sum Insured (`) 1450000
Other Riders and Benefits ( `)
Protector Rider -
Hospital Daily Cash Rider
-
SI (Max. 30 days)
Critical Advantage Rider SI - - - - - -
IPA Rider SI - - - - - -
Critical Illness SI - - - - - -
Nominee Details
Nominee Name : Mrs Shalini Sinha Relationship to Policyholder: Wife
The nominee must be an immediate relative of the policyholder. For all other Insured Persons the policy holder shall be the nominee.
Premium Calculation (`)
Net Premium 22547 CGST@0% 0
Discounts 0 SGST/UTGST@0% 0
Loadings 0 IGST@18% 4058
Taxable Premium 22547 Any other Cess or Taxes 0
Gross Premium 26605
Gross Premium (in words) Rupees Twenty-Six Thousand Six Hundred Five
The stamp duty of Rs. 1/- ( Rupees One Only ) paid vide e-stamp Certificate No. LOA/CSD/303/2022/1381 dated 29/03/2022.
Original for Recipient/ Duplicate for Supplier
Whether tax is payable on reverse charge basis: No

Exclusion(s) / Special Condition(s) (Refer the leaflet attached in the policy document w.r.t. exclusions) :
Member ID No. Name Exclusion Type Applicable Health Condition Exclusion Portability/ Renewal Benefit
on SI Duration
(Years)
202001000192789 KUNAL . For Rs 250000(Rupees Two Lakhs
2 Fifty Thousand) Sec C1 (i) and Sec
C1 (ii) Sec C1 (iii) of the policy
wording is waived.

For Rs 500000(Rupees Five Lakhs)

Sec C1 (i) and Sec C1 (ii) Sec C1 (iii)
of the policy wording is waived.

For Rs 500000(Rupees Five Lakhs)

Sec C1 (i) and Sec C1 (ii) Sec C1 (iii)
of the policy wording is waived.

HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, 165/166 Backbay Reclamation, H.T.Parekh Marg,
Churchgate, Mumbai - 400 020. UIN: HDHHLIP21378V062021. Customer Service Address: D 301, 3rd Floor, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400078. Customer Service
No : +91 22-62346234 /+91-120 6234 6234 www.hdfcergo.com
 HDFC ERGO General Insurance Company Limited

Policy Schedule - Easy Health Floater Standard

Exclusion(s) / Special Condition(s) (Refer the leaflet attached in the policy document w.r.t. exclusions) :
Member ID No. Name Exclusion Type Applicable Health Condition Exclusion Portability/ Renewal Benefit
on SI Duration
(Years)

For Rs 250000(Rupees Two Lakhs

Fifty Thousand) Sec C1 (i) of the
policy wording is waived and Sec C1
(ii) is reduced to 1 year and Sec C1
(iii) is reduced to 2 years.
202001000192789 Master Shorya Samarth For Rs 250000(Rupees Two Lakhs
4 Fifty Thousand) Sec C1 (i) and Sec
C1 (ii) Sec C1 (iii) of the policy
wording is waived.

For Rs 500000(Rupees Five Lakhs)

Sec C1 (i) and Sec C1 (ii) Sec C1 (iii)
of the policy wording is waived.

For Rs 500000(Rupees Five Lakhs)

Sec C1 (i) and Sec C1 (ii) Sec C1 (iii)
of the policy wording is waived.

For Rs 250000(Rupees Two Lakhs

Fifty Thousand) Sec C1 (i) of the
policy wording is waived and Sec C1
(ii) is reduced to 1 year and Sec C1
(iii) is reduced to 2 years.
202001000192789 Mrs Shalini Sinha For Rs 250000(Rupees Two Lakhs
3 Fifty Thousand) Sec C1 (i) and Sec
C1 (ii) Sec C1 (iii) of the policy
wording is waived.

For Rs 500000(Rupees Five Lakhs)

Sec C1 (i) and Sec C1 (ii) Sec C1 (iii)
of the policy wording is waived.

For Rs 500000(Rupees Five Lakhs)

Sec C1 (i) and Sec C1 (ii) Sec C1 (iii)
of the policy wording is waived.

For Rs 250000(Rupees Two Lakhs

Fifty Thousand) Sec C1 (i) of the
policy wording is waived and Sec C1
(ii) is reduced to 1 year and Sec C1
(iii) is reduced to 2 years.

Claim Administrator : HDFC ERGO GENERAL INSURANCE COMPANY LTD For and on behalf of HDFC ERGO General Insurance Company Limited

Location: Mumbai Authorized Signatory

Date: 28/12/2023

HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, 165/166 Backbay Reclamation, H.T.Parekh Marg,
Churchgate, Mumbai - 400 020. UIN: HDHHLIP21378V062021. Customer Service Address: D 301, 3rd Floor, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400078. Customer Service
No : +91 22-62346234 /+91-120 6234 6234 www.hdfcergo.com
 HDFC ERGO General Insurance Company Limited

Terms and Conditions

(1) This card would be valid till your relationship with HDFC ERGO General Insurance Company Limited /
Policy No.: 2806203700409304000 This card i s invalid if the policy is cancelled (2) In case of renewal please refer original policy number (3)
This card is issued for the purpose of identification only and does not entail automatic cashless facility at
the network hospital. (4) A photo ID issued b y any government authority i s to be produced to avail
cashless facility. (5) Please apply for cashless facility 48 hours prior to admission in case of planned
admissions and within 24 hours of admission in case of emergency.(6) All terms and conditions of the
Insured Name Gender policy would be applicable while processing your cashless request. (7) In case your cashless facility is
Mrs Shalini Sinha Female denied due to any reason, please submit the claim for reimbursement. Denial of cashless facility does not
Master Shorya Samarth Male indicate rejection of the claim. (8) Please read policy documents carefully for detailed terms and
conditions. For claim status visit help section on our web site www.hdfcergo.com. Alternatively you may
Kunal . Male write to us at Healthclaims@hdfcergo.com.

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146 CIN: U66030MH2007PLC177117.
Registered & Corporate Office: 1st Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh
Marg, Churchgate, Mumbai – 400 020. Health Claim Services Address : HDFC ERGO General Insurance
Company Limited Stellar IT Park, Tower-1 , 5th Floor, C - 25, Noida, Sector 62, 201301, Uttar Pradesh.
Service No. 022-62346234/ 0120-62346234Email: healthclaims@hdfcergo.com.Trade Logo displayed
above belongs to HDFC Ltd and ERGO International AG and used by the Company under license.

HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, 165/166 Backbay Reclamation, H.T.Parekh Marg,
Churchgate, Mumbai - 400 020. UIN: HDHHLIP21378V062021. Customer Service Address: D 301, 3rd Floor, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400078. Customer Service
No : +91 22-62346234 /+91-120 6234 6234 www.hdfcergo.com