Group accident Guard policy

UIN : NBHPAGP24072V012324

Insurance information Sheet

Insured Person Name: Mr Aman Mishra Intermediary Code: CA0574

Correspondenc e Address: Lediha, Lediha, Ghaz ipur, Intermediary Name: INDIA POS T PAYMENTS
Uttar Pradesh, India BANK LIMITED

Plac e of S upply: Uttar Pradesh Intermediary Contac t No: 155299

S tate Code : 9 Partner Applic ation No: AH8CC226S 6Q

Group Polic yholder Name: INDIA POS T PAYMENTS BANK Certific ate No:PA9990012114-10078074
LIMITED
Renewal No : NA
Polic y Number: PA9990012114
Endorsement No: NA

Insured Person E-mail ID:

Premium Details
Member ID: GS T as Total Gross
Net Premium Applic able Premium
INR 470 INR 85 INR 555

Insurer Details

Insured Person Name: Gender DOB Relationship with Insured Person

Aman Mishra Male 01/07/2000 S elf

Nominee Details

Name: Gender DOB Relationship with Insured Person Address

Arti 02/01/1977 Mother

Coverage Details
Sr
Coverages Sum Assured
No
1 Ac c idental Cover S um Insured (S I) 1000000
2 Ac c idental Death (AD) 1000000
Ac c idental Permanent Total
3 1000000
Disability (PTD)
Ac c idental Permanent Partial
4 up to 1000000
Disability (PPD)
5 Child Wedding INR 50,000
Broken Bones on Indemnity Basis (
6 Up to INR 25000
as per Ac tuals )
Burns (as per the grid mentioned
7 INR 10,000
in Polic y Doc ument)
Deduc tibles of 3 months upto 10 weeks at the rate of 1%
8 Comatose benefit
of Ac c idental Cover S I per week
Ac c idental Medic al upto INR 100,000, without OPD where c laims are linked to
9
Reimbursement AD/PTD/PPD
10 Last Rites Expenses INR 5000
11 Child Educ ation INR 50,000
12 Tele c onsultations (GP) Unlimited
13 Daily Cash Benefit 500 per Day
14 ICU Cash Benefit 1000 per day
15 Maternity Covered from Day 1
16 Annual Health Chec k up 1
17 Initial Waiting Period 30 days
18 PED/S pec ific Waiting Period Waived

Conditions if any :-
In c onsideration of additional premium, Point No. 10 under S ec tion 3- General Exc lusions
pertaining to Ac t of Terrorism stands deleted.
The Benefits whic h are mentioned in this Certific ate of Insuranc e shall only be available
under the Polic y.

Important Exc lusions:

The Polic y does not provide benefits for any loss resulting in whole or in part from, or expenses
inc urred, in respec t of:

A. Any Pre-existing Condition, any c omplic ation arising from it; suic ide, attempted suic ide (whether
sane or insane) or intentionally self-inflic ted Injury or illness being under the influenc e of drugs,
alc ohol, or other intoxic ants or halluc inogens unless properly presc ribed by a Physic ian and taken
as presc ribed Partic ipation in an ac tual or attempted felony, riot, c rime, misdemeanor(exc luding
traffic violations) or c ivil c ommotion Mosquito bite and resultant diseases;

B. The detailed list of exc lusions, standard terms and c onditions, inc luding the exc lusion of pre-
existing ailments/diseases, were fully explained to you and for full details thereof please refer to the
Polic y wordings: Answer given by You: Yes, I/we have been explained in full the details of exc lusions,
standard terms and c onditions inc luding the exc lusion of pre-existing ailments/diseases and
knowing the same I/we have opted and proposed for this Polic y

C. The c ontents of the proposal [transc ript of proposal of you is this doc ument] and c onnec ted
doc uments have been fully explained to him and you have fully understood the signific anc e of the
proposed c ontrac t basis whic h you have c onfirmed for polic y issuanc e.

D. In c ase of Disagreement or objec tion or any c hanges with respec t to information, dec larations,
Terms and Conditions, exc lusions and c ontents mentioned hereinabove, please c ontac t our toll free
number & register your objec tions / c hanges / disagreement to the c ontents of this transc ript or
 you may also send us email or written c orrespondenc e at the following details within a period of 15
days from date of your rec eipt of this transc ript along with Polic y.

Commenc ement of risk c over under the polic y is subjec t to rec eipt of premium by Niva Bupa Health
Insuranc e Company Limited.

Consolidated S tamp Duty has been paid to the state Exc h

General Conditions:

Inc ome tax benefit u/s 80D is available as per the existing Inc ome Tax Laws.Please c onsult your tax
advisor for more details.

This Polic y is subjec t to the terms, c onditions and exc lusions mentioned in the Antyodaya S hramik
S uraksha Yojana, Niva Bupa Health Insuranc e Co. ltd., Produc t UIN: NBHPAGP24072V012324 The
c ontrac t will be c anc elled ab intio in c ase; the c onsideration under the polic y is not realiz ed. Polic y
issuing offic e : Delhi , Consolidated S tamp Duty deposited on the Master Polic y.

Goods and S ervic e Tax Registration No.: 09AAFCM7916H1Z6

The c over may be renewed on sole disc retion of Niva Bupa Health Insuranc e Co Ltd subjec t to member
being the part of the group at the time of renewal also. In c ase You c ease to be a member of the
group, the c over will stand c anc elled as per T& C of the polic y

Where the proposal form is not rec eived, information obtained from insured, whether orally or
otherwise, is c aptured in the polic y doc ument.Disc repanc ies, if any, in the information c ontained in
the polic y doc ument may be pointed out by an insured within 15 days from the polic y issue date after
whic h information c ontained in the polic y doc ument shall be deemed to have been ac c epted as
c orrec t.

For registration of c laims You may c ontac t us at: Claims Department, Niva Bupa Health Insuranc e
Company Limited, 2nd Floor, Plot No D-5, S ec tor 59, Noida, Gautam Budhnagar – 201301 Fax No.: 011-
3090-201

For help and more information: