HDFC ERGO General Insurance Company Limited

2825100472798900000

BASKARAN G
241, ANANTHAGIRI V, SATHGUR POST, PERNAMBUT
VELLORE, 635810
TAMIL NADU
Contact No : 8148877433

Date : 16/05/2024

We welcome you to be a part of our family!

Your Health insurance policy reference no 2825100472798900000 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.

For HDFC ERGO General Insurance Company Ltd.

Ankur Bahorey
Head - Retail Business Group

HDFC ERGO General Insurance Company Limited

Dear Baskaran G,
Subject : Certificate for the purpose of deduction under section 80 D of Income Tax (Amendment) Act, 1986
This is to certify that we have received an amount of ` 68,516.00 (RUPEES SIX EIGHT THOUSAND FIVE HUNDRED AND SIXTEEN RUPPES Only)
towards premium for Health Suraksha Policy, policy no. 2825100472798900000 issued to BASKARAN G for the period 16/05/2024 to 15/05/2025.

Note:

1. This is subject to the provisions of Section 80D of income tax (Amendment) Act, 1986 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 policy holder.
For HDFC ERGO General Insurance Company Ltd.
Date : 16/05/2024
Policy Issuing Office: Mumbai

Duly Constituted Attorney

HDFC ERGO General Insurance Company Limited (Formerly HDFC General Insurance Limited) UIN:HDFHLIP18019V031718 | IRDAI Reg No.146 | CIN : U66030MH2007PLC177117
Registered & Corporate Office: Customer Service Address: Customer Service no : 022 - 6234 6234 / 0120 - 6234 6234
1st Floor, HDFC House, 165/166 Backbay Reclamation, D 301, 3rd Floor, Eastern Business District (Magnet Mall), Telephone: 022 6638 3600 Fax : 022 6638 3699
H.T.Parekh Marg, Mumbai - 400 020 LBS Marg, Bhandup (West), Mumbai - 400 078 Email : [email protected]
HDFC ERGO General Insurance Company Limited 2825100472798900000
POLICY SCHEDULE Health Suraksha Policy
GOLD PLAN

Policy Details
Policy No. 2825 1004 7279 8900 000 Premium Frequency Yearly
Period of From 16/05/2024 17:09 hrs Policy Type Family Floater
Insurance To 15/05/2025 Midnight PAN 0

2825100472798900000 Issuance Date 16/05/2023

BASKARAN G
241, ANANTHAGIRI V, SATHGUR POST, PERNAMBUT Proposer Name BASKARAN G
VELLORE
TAMIL NADU, 635810
Contact No : 8148877433

Email ID : [email protected]

Insured Person’s Details & Sum Insured

Insured's Name Relation with Gender Date of Nominee Name Nominee 1st Policy Sum Insured CB Amount Pre Existing
policy holder Birth Relationship Inception (`) (`) Disease
BASKARAN G Self Male 23/04/1989 KAVITHA G Sister 16/05/2024 3000000 0

GOVINDARAJ GOPAL Father Male 07/11/1958 16/05/202

4

Coverage Details
Coverage Details Coverage Details
In Patient Treatment Covered Pre-hospitalization (days) 60
Post-hospitalization (days) 90 Day Care Procedures Covered
Domiciliary Treatment Covered Organ Donor Covered
Emergency Ambulance Limit per hospitalisation Upto Rs. 3500 AYUSH:Ayurvedic/Unani/Homeopathy/Sidha Covered
Limit for Maternity (Normal) Rs. Baby Expenses Included in
Maternity Covered 15000 & Limit for Maternity (LSCS) New Born baby Covered Maternity Limit : Maximum Liability
Rs. 25000 Rs 2000
Pre/Post Natal Expenses included
Upto 1% Sum Insured,Maximum
Pre/Post Natal Expenses Covered in Maternity Limit : Maximum Health check up per family (post 4 claims free year)
Upto Rs 5000
Liability Rs 1500
Convalescence Benefit Minimum Hospitalisation of 10 1% of Sum Insured subject to a
E Opinion for Critical Illness Covered
continuous days maximum of Rs. 10,000
10% of Sum Insured; Maximum
Enhanced Cumulative Bonus Regain Benefit 100% of basic Sum Insured
100%
The Policy Wording attached herewith includes all the standard coverages offered b y the Company to its customers. Your entitlement for coverage/benefits shall be restricted to the coverage/benefits a s mentioned in
this Policy Schedule issued to you. Please read the Policy Wording in conjunction with the Policy Schedule. For any clarification, please call our toll free number.

Premium Details (`)

Basic Premium 57000.91
Enhanced Cumulative Bonus(Loading) 354.70
Regain Benefit(Loading) 709.40
Total Premium excluding Taxes 58064.00
Loading 0.00
GST 18% : Central Tax 9%( `1372.50)+ State Tax 9%( `1372.50) & Kerala Flood Cess At 1% ( `0.00 ) 10451.00
Total Premium 68516.00

Payment Details
Cheque No./DD/Fund Transfer Date Bank Name
HI1908002973 16/05/2024 BizDirect

Special Conditions
Age proof/identity proof will be collected in event of claim under the policy.

Invoice No. 100472798900000 HSN Code 9971

For Claim Services Phone 022 - 6234 6234 / 0120 - 6234 Fax no 18602000600 Email [email protected]
Processing Centre HDFC ERGO General Insurance Company Ltd. 5th floor, Tower 1, Steller IT Park, C-25, Sector-62,Noida-201301.
For any other query call toll-free 1800 2 700 700 or email us at [email protected] or log on to www.hdfcergo.com
If the premium is not realised the policy shall be void from inception.
Consolidated stamp duty for this Insurance Policy i s paid by Demand Draft, vide Receipt/Challan no. CSD/36/2019/2289/19 dated 27-05-2019 as prescribed in
Government Notification Revenue and Forest Department No. Mudrank 2004/4125/CR690/M-1, dated 31/12/2004.. Goods and Service Tax Registration No:
27AABCL5045N1Z8. Goods and Service Tax for this invoice is not payable under reverse charge basis.
Branch :LEELA BUSINESS PARK, 6TH FLR, ANDHERI - KURLA RD, MUMBAI, 400059. Phone No. :+91-22-66383600
*1* *1*

HDFC ERGO General Insurance Company Limited (Formerly HDFC General Insurance Limited) UIN:HDFHLIP18019V031718 | IRDAI Reg No.146 | CIN : U66030MH2007PLC177117
Registered & Corporate Office: Customer Service Address: Customer Service no : 022 - 6234 6234 / 0120 - 6234 6234
1st Floor, HDFC House, 165/166 Backbay Reclamation, D 301, 3rd Floor, Eastern Business District (Magnet Mall), Telephone: 022 6638 3600 Fax : 022 6638 3699
H.T.Parekh Marg, Mumbai - 400 020 LBS Marg, Bhandup (West), Mumbai - 400 078 Email : [email protected]