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Policy Certificate

- Udaybhan Yadav has been issued an Income Protect policy by ICICI Lombard for 1 year starting September 18, 2023. - The policy provides coverage of Rs. 16,125 for loss of income due to unemployment, critical illness, and major surgeries. It will pay benefits of 3 EMIs for any covered event. - Udaybhan's details including name, address, contact number, and occupation have been provided. He is the insured person under the policy. - The basic premium for the policy is Rs. 411.67 with CGST of 9% amounting to Rs. 37.05.

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UDAYBHAN YADAV

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0% found this document useful (0 votes)

413 views5 pages

Policy Certificate

Uploaded by

UDAYBHAN YADAV

We take content rights seriously. If you suspect this is your content, claim it here.

Available Formats

Download as PDF, TXT or read online on Scribd

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RISK ASSUMPTION LETTER

Ref. No.: W243975556

Date: 18-09-2023

Dear Sir / Madam,

We thank you for placing your confidence with ICICI Lombard for your Insurance needs.

Please find attached herewith Policy No. : 4151/307041182/00/000 , which has been issued based on the
details furnished by the applicant in the proposal form

Name of the Applicant: UDAYBHAN YADAV

Date of Birth: XX-XX-1997
Mailing Address: MAYA APARTMENT KHUSHI NAGAR MANSAROWAR GARDEN NEW DELLHI, NEW
DELHI,DELHI, 110015
Mobile No.: 88******39
Product Name: Income Protect
Policy Account No: 3399051
Policy Tenure:
Policy Sanction Amount:15000
Policy Sanction Date: 18/09/2023
Period of Insurance: From 00:00 hrs 18-Sep-2023 To 23:59 hrs 17-Sep-2024
Policy Duration (years): 1

Insured Details

Name of the Relationship Date Of Age in Occupation Nominee Nominee Pre

Insured with Applicant Birth Years Name Relationship Existing
with Applicant illness
UDAYBHAN SELF 01/01/1997 26 Salaried
YADAV full-time

Please go through the details as furnished in the format and the policy document. Please confirm that same
are in order. In case there is any discrepancies / variations, you are requested to write back to us immediately
at [email protected] or contact at 24 hour helpline number 1800 2666 for necessary
changes / rectification.

In the absence of any communication from you in this connection within a period of 15 days of receipt of this
letter, we would take it that the issued policy is in order and as per your proposal.

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLGP21399V032021
Mailing Address: Registered Office: Toll free no.: 1800 2666
ICICI Lombard General Insurance Company Limited, ICICI Lombard House, 414 Veer Savarkar Alternate No.: +918655 222 666 (chargeable)
Interface Building No.: 16, 601 / 602, 6th Floor, New Marg, Near Siddhi Vinayak Temple, Email: [email protected]
Link Road, Malad (West), Mumbai - 400 064. Prabhadevi, Mumbai - 400 025. Website: www.icicilombard.com 1/5
Income Protect
Preamble
On receipt of full premium (First Installment in case the customer has opted for Periodic Premium Payment option)
from the Policyholder as named in this Schedule, Income Protect 4151/IP/299558776/00/000 dated 18-Sep-2023
has been issued at Mumbai, by ICICI Lombard General Insurance Company Limited to the Policyholder, BHANIX
FINANCE AND INVESTMENT LIMITED as specified in the Policy, and is governed by, and is subject to, the terms,
conditions & exclusions therein contained or otherwise expressed in the said Policy.
The certificate issued to the customers/employees/members of BHANIX FINANCE AND INVESTMENT LIMITED under
the signature of an authorized signatory of ICICI Lombard General Insurance Company Limited, represents the
availability of the Benefits under the Policy to the Insured Person named below, subject to the terms, conditions and
exclusions expressed in the said Policy, but not exceeding the Sum Insured as specified below.
corporate

PART I OF THE SCHEDULE

Applicant Name UDAYBHAN YADAV Policy No. 4151/307041182/00/000

Address MAYA APARTMENT KHUSHI Period of Insurance From 00:00 hrs 18-Sep-2023 To
NAGAR MANSAROWAR 23:59 hrs 17-Sep-2024
GARDEN NEW DELLHI, NEW
DELHI,DELHI, 110015
Contact No. 88******39 Policy Tenure (in Years) 1
Policy Account Number 3399051 Policy Tenure
Policy Sanction Date 18/09/2023 Policy Sanction Amount 15000
Policy Activated Date 18/09/2023 Applicant PAN Number AZXXXXXX86A
Nature of Assignment Name of Assignee
Status in the Policy Alternate Policy No. 3399051
Email Address UD**********@GMAIL.COM Policy Issuing Office Prabhadevi, Mumbai
Previous Policy No. Policy Issued On 20-Sep-2023
GSTIN Number Service Branch Name DELHI GREEN PARK
(Customer)
Servicing Branch 3rd floor, Veera Tower, above Invoice Number 1009231666104
Address ICICI Bank, S-26,27,28 Green
Park extn Market, New Delhi ,
District South Delhi , Pin
code - 110016 New
Delhi.NEW DELHI DELHI -
110016

Politically Exposed Person (PEP)/close relative of PEP: No

Insured Details

Name of the Relationship Date Of Age in Gender Pre Occupation Nominee Nominee
Insured with Birth Years Existing Name Relationship
Applicant illness with Applicant

UDAYBHAN Salaried
SELF 01/01/1997 26 Male
YADAV full-time

2. Details of the Insured Event along with the Benefits (as per tablebelow):

Cover Name Sum Insured Benefit Amount 0

Loss of income due to loss of employment 16125 3 EMIs
Critical illness benefit 16125 3 EMIs

ICICI Lombard General Insurance Company Limited

IL GSTIN Registration No. HSN/SAC Code The stamp duty of `1 paid vide deface no.
997133 / GENERAL INSURANCE CSD6142023662 dated 20-Feb-2023
07AAACI7904G1ZP
SERVICES
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.

Agent / Broker / Intermediary Details

AAPT
INSURANCE
Name BROKERS Code DB86421 Contact No. 9599972255
PRIVATE
LIMITED
SPECIAL CONDITION

Important Notes:
1. Insurance cover will start only on receipt of full premium (First Installment in case the customer has opted for
Periodic Premium Payment option) stated in PART I of the Policy Schedule by ICICI Lombard General
Insurance Company Limited.
2. Insurance cover is subject to the terms and conditions mentioned in the Policy wordings provided to you with this
Certificate.
3. On renewal of policy benefits and terms & conditions of policy including premium may be subject to change.
4. The above covers would not be applicable for persons occupied in underground mines, explosives and electrical
installations on high tension lines unless otherwise covered and stated in the Policy Schedule.
5. Major exclusions: Intentional self-injury, suicide or attempted suicide whilst under the influence of intoxicating
liquor or drugs, any loss arising from an act of breach of law with or without criminal intent. Please refer to the
Policy wordings for a complete list of exclusions.
6. For any endorsements such as name correction or change in nominee details, you can contact us at Toll Free
Number 1800-2666 or Email us at [email protected] or visit our nearest branch.
7. The claimant can contact us at Toll Free Number 1800-2666 or Email us at [email protected]
for lodging the claim.
8. Address for claim notification: IL Health Care, ICICI LOMBARD HEALTHCARE ICICI BANK TOWER, PLOT
NO.12, FINANCIAL DISTRICT, NANAKRAM GUDA, GACHIBOWLI, HYDERABAD, ANDHRA PRADESH PIN CODE:
500032

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Sheet and Policy-wordings

ICICI Lombard General Insurance Company Limited

Tax Certificate
To,
UDAYBHAN YADAV
MAYA APARTMENT KHUSHI NAGAR MANSAROWAR GARDEN
NEW DELLHI, NEW DELHI,DELHI, 110015

Subject: Premium certificate for the purpose of deduction under section 80D of Income Tax Act, 1961 and any
amendments made thereafter.

Dear UDAYBHAN YADAV,

This is to certify that the Company has received `486 towards premium for the period from 18-Sep-2023 to
17-Sep-2024