*114266085*

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory and Development Authority of India [IRDAI] vide Regd. No.113)
Regd. Office: Bajaj Allianz House, Airport Road, Yerwada, Pune 411006 (India)

Welcome to Bajaj Allianz Family

Bajaj Allianz General Insurance Co Ltd, VTP KP SQUARE,
Policy issuing office and Correspondence address for 8th Floor, Unit No-809 to 816,Telco RoadIndira Nagar
communication by policyholder for claim, service request, notice, Mohan Nagar MIDC, Chinchwad, PUNE-411019 Phone No
summons, etc. :9607905695
Proposer Name VATSALABAI G BALWADKAR Policy Number OG-20-2016-8429-00000056

VATSALABAI G BALWADKAR
A/P BALEWADI SR NO 33 BEHIND MITCON
COLLEGE NR,

PUNE, MAHARASHTRA,
Pin - 411045
Customer ID : 43247399 *OG-20-2016-8429-00000056*

Dear Customer,

Thank you for choosing Bajaj Allianz General Insurer as your preferred insurer. Bajaj Allianz
General Insurance Company Limited, a consistently profitable insurer enjoys a reputation of
expertise, stability and strength. We are a customer focused market leader present in over 200
locations across India. As an organization we strive to understand the risk management needs of
our consumers and translate it into affordable products and services of global quality that deliver
value for money. Bajaj Allianz has an ISO Certified claims, Operations and Services processes and
has received iAAA rating for the last three consecutive years from ICRA Limited, an associate of
Moody's Investors Service, for claims paying ability. The rating indicates highest claims paying
ability and a fundamentally strong position in the industry.

We request you to kindly go through the contents of the policy schedule and the terms and
conditions. In case of any clarification or disagreement, please write to us at
[email protected] within fifteen days of receipt of this policy.

We assure you the best of our services and look forward to a continual patronage and association
with you.

For & on the behalf

Bajaj Allianz General Insurance Company Ltd.

Authorized Signatory

For help and more information: Page 1 of 5

Contact our 24 Hour Call Centre at 1800-209-5858, 1800-102-5858 (Toll Free)
Email: [email protected] , Website www.bajajallianz.com

Corporate Identification Number: U66010PN2000PLC015329 | Demystify Insurance https://www.bajajallianz.com/blog.html

http://www.facebook.com/BajajAllianz http://twitter.com/BajajAllianz https://www.linkedin.com/company/bajaj-allianz-general-insurance

 *114266085*

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory and Development Authority of India [IRDAI] vide Regd. No.113)
Regd. Office: Bajaj Allianz House, Airport Road, Yerwada, Pune 411006 (India)

HEALTH GUARD - POLICY SCHEDULE IRDAI/HLT/BAGI/P-H/V.II/113/16-17

Bajaj Allianz General Insurance Co Ltd, VTP KP SQUARE,
Policy issuing office and Correspondence address for 8th Floor, Unit No-809 to 816,Telco RoadIndira Nagar
communication by policyholder for claim, service request, notice, Mohan Nagar MIDC, Chinchwad, PUNE-411019 Phone No
summons, etc. :9607905695
Proposer Name VATSALABAI G BALWADKAR Policy Number OG-20-2016-8429-00000056

PROPOSER DETAILS POLICY DETAILS

Policy Issued on 19-APR-2019
A/P BALEWADI SR NO 33 BEHIND
MITCON COLLEGE NR, Period of From: 20-APR-2019 00:01 Hrs.
Proposer Address Insurance To : 19-APR-2020 Midnight
PUNE, MAHARASHTRA, Customer ID 43247399
Pin - 411045
Policy Status Issued
Previous Policy No. OG-19-2016-8429-00000069 Expiry Date 19-Apr-2019
Insured Member Details
Member Name Customer ID Gender Date Of Birth Age Relation Nominee Name & Relation
VATSALABAI G BALWADKAR 43247399 Female 01-JAN-1963 56 SELF SACHIN OTHERS
GSTIN / UIN Place of Supply/State Code/ Name
NA 27 - Maharashtra
Company GST No.: Invoice No.:
27AABCB5730G1ZX 96678404/2
Company PAN:
AABCB5730G
Sum Insured & Cover Details
Daily Cash for
Inpatient Hospitalization Convalescence Benefit Accompanying an Maternity Expenses
Member Name Treatment Insured Child
Sum Insured Cumulative Bonus Sum Insured Sum Insured Sum Insured
VATSALABAI G 2,00,000.00 1,00,000.00(50%) 5,000.00 5,000.00 NA.00
BALWADKAR
Premium Details
Description Amount(INR) Description Amount(INR)
Base Premium 10,285.00 Less: Family Discount 0.00
Less: Long Term Policy Discount 0.00
Less: Employee Discount 0.00
Premium Payment Zone B Less: Voluntary Co-payment Discount @ 10% / 20% 0.00
Voluntary Co-payment Opted- 10%/20% 0.00% Net Premium * 10,285.00
State GST (9%) 926.00
Gross Premium: Rupees Twelve Thousand One Hundred Central GST (9%) 926.00
Thirty Seven Only
Gross Premium 12,137.00

For help and more information: Page 2 of 5

Contact our 24 Hour Call Centre at 1800-209-5858, 1800-102-5858 (Toll Free)
Email: [email protected] , Website www.bajajallianz.com

Corporate Identification Number: U66010PN2000PLC015329 | Demystify Insurance https://www.bajajallianz.com/blog.html

http://www.facebook.com/BajajAllianz http://twitter.com/BajajAllianz https://www.linkedin.com/company/bajaj-allianz-general-insurance

 *114266085*

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory and Development Authority of India [IRDAI] vide Regd. No.113)
Regd. Office: Bajaj Allianz House, Airport Road, Yerwada, Pune 411006 (India)

HEALTH GUARD - POLICY SCHEDULE IRDAI/HLT/BAGI/P-H/V.II/113/16-17

Bajaj Allianz General Insurance Co Ltd, VTP KP SQUARE,
Policy issuing office and Correspondence address for 8th Floor, Unit No-809 to 816,Telco RoadIndira Nagar
communication by policyholder for claim, service request, notice, Mohan Nagar MIDC, Chinchwad, PUNE-411019 Phone No
summons, etc. :9607905695
Proposer Name VATSALABAI G BALWADKAR Policy Number OG-20-2016-8429-00000056

“ANY CLAIM AS A RESULT OF DISEASE/ CONDITIONS CONTRACTED DURING THE BREAK

PERIOD STANDS EXCLUDED” THIS POLICY EXCLUDES FOR ANY CLAIMS IN RESPECT OF ANY
Special Terms & Conditions DISORDER, INJURY, DISEASE, DISABILITY OR TREATMENT WHETHER DIRECTLY OR
INDIRECTLY CAUSED BY, OR ATTRIBUTABLE TO BREAK PERIOD OR RELATED TO AILMENT
OF THAT BREAK PERIOD
Member Name Special Condition Member level
Special Exclusions
VATSALABAI G BALWADKAR NA
1st Policy Inception Date 20/04/2018
Maternity benefit is applicable for female member/s only.
Additional Remarks Daily Cash for Accompanying an Insured Child benefit is applicable only for children up to 12 years
This is to certify that VATSALABAI G BALWADKAR has paid RS.12,137.00 towards Health Insurance
80 D Certificate for Period and Policy Number as mentioned on the Policy Schedule and is eligible for Deduction
under Section 80-D of Income Tax (Amendment) Act, 1986
Receipt Number : 2016-00217415 | Date : 19-APR-19 | Premium Payer ID : 43247399 | Float : CF
Premium Details
** If Premium paid through Cheque, the Policy is void ab-initio in case of dishonour of Cheque
Financial Institution Ref. No. NA

Agency Code & Name 0/DIRECT

Contact No. 0-0 E-Mail NA
For & on the behalf
Bajaj Allianz General Insurance Company Ltd.

This document is digitally signed, hence counter signature / stamp is not

Authorized Signatory required.
null

Principal Location : Bajaj Allianz

House, Airport Road, Yerwada, Pune
- 411006 PH:66026666 | Services
Accounting Code : 997133 -
Accident and health insurance
services. No reverse charge is
payable on these services.
Schedule (2) | Printed on : 17-APR-2025 01:24:26|[email protected]|Web|Sub 0 / PVT-555

For help and more information: Page 3 of 5

Contact our 24 Hour Call Centre at 1800-209-5858, 1800-102-5858 (Toll Free)
Email: [email protected] , Website www.bajajallianz.com

Corporate Identification Number: U66010PN2000PLC015329 | Demystify Insurance https://www.bajajallianz.com/blog.html

http://www.facebook.com/BajajAllianz http://twitter.com/BajajAllianz https://www.linkedin.com/company/bajaj-allianz-general-insurance

 *114266085*

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory and Development Authority of India [IRDAI] vide Regd. No.113)
Regd. Office: Bajaj Allianz House, Airport Road, Yerwada, Pune 411006 (India)

HEALTH GUARD - ANNEXURE

Bajaj Allianz General Insurance Co Ltd, VTP KP SQUARE,
Policy issuing office and Correspondence address for 8th Floor, Unit No-809 to 816,Telco RoadIndira Nagar
communication by policyholder for claim, service request, notice, Mohan Nagar MIDC, Chinchwad, PUNE-411019 Phone No
summons, etc. :9607905695
Proposer Name VATSALABAI G BALWADKAR Policy Number OG-20-2016-8429-00000056

HEALTH & WELLNESS CARD

HEALTH & WELLNESS CARD

Customer ID : 43247399
Policy No : OG-20-2016-8429-00000056
ID Card No : 20-96678404-1
Valid Up to : 19-APR-2020
VATSALABAI G BALWADKAR (56Yrs.)

Bajaj Allianz General Insurance Company Limited

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance
Regulatory and Development Authority of India[IRDAI] vide Reg No. 113)
Regd.Office: Bajaj Allianz House, Airport Road, Yerwada, Pune-411006 (India)
Cashless hospitalization in network hospitals can be obtained only if this card is
produced along with a letter of authorization from Bajaj Allianz except for emergency
cases. This is subject to terms and conditions of the policy. Please quote your ID number
for assistance. Intimation to Bajaj Allianz Helpline is mandatory in case of any
hospitalization.
HOSPITAL ALERT: In emergency, Patient may approach with id card; please call Bajaj
Allianz helpline to verify coverage and cashless authorization.
For help and more information:
Contact our 24 Hour Call Center at 1800-209-5858 (Toll Free), 30305858
(chargeable,add area code before this number in case of mobile call)
Email: [email protected], Website www.bajajallianz.com
Corporate Identification Number: U66010PN2000PLC015329

For help and more information: Page 4 of 5

Contact our 24 Hour Call Centre at 1800-209-5858, 1800-102-5858 (Toll Free)
Email: [email protected] , Website www.bajajallianz.com

Corporate Identification Number: U66010PN2000PLC015329 | Demystify Insurance https://www.bajajallianz.com/blog.html

http://www.facebook.com/BajajAllianz http://twitter.com/BajajAllianz https://www.linkedin.com/company/bajaj-allianz-general-insurance

 *114266085*

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory and Development Authority of India [IRDAI] vide Regd. No.113)
Regd. Office: Bajaj Allianz House, Airport Road, Yerwada, Pune 411006 (India)

HEALTH GUARD - RECEIPT

Bajaj Allianz General Insurance Co Ltd, VTP KP SQUARE,
Policy issuing office and Correspondence address for 8th Floor, Unit No-809 to 816,Telco RoadIndira Nagar
communication by policyholder for claim, service request, notice, Mohan Nagar MIDC, Chinchwad, PUNE-411019 Phone No
summons, etc. :9607905695
Proposer Name VATSALABAI G BALWADKAR Policy Number OG-20-2016-8429-00000056

RECEIPT

Receipt Number 2016-00217415

Receipt Date 19-APR-19
Business Channel DI

Received with thanks from VATSALABAI G BALWADKAR

(Customer ID : 43247399) a total sum of Rupees Twelve Thousand One Hundred Thirty Seven Only by,

Instrument Type Instrument No Instrument Date Bank Name Branch Name Amount
Cheque 000004 19/04/2019 STANDARD CHARTERED BANK KALYANI NAGAR 12,137
Total Amount 12,137.00
Note : 114266085
VATSALABAI G BALWADKAR
Issuance of this receipt does not amount of acceptance of the risk by Bajaj Allianz General Insurance Company Limited. The
insurance cover for the risk shall be as per the terms and conditions of the Insurance Policy if and when issued.
* Cheque/DD/PO receipt is valid subject to realisation of the instrument

For & on the behalf

Bajaj Allianz General Insurance Company Ltd.

Authorized Signatory

Regd. Office: Bajaj Allianz House, Airport Road, Yerwada, Pune - 411006

For help and more information: Page 5 of 5

Contact our 24 Hour Call Centre at 1800-209-5858, 1800-102-5858 (Toll Free)
Email: [email protected] , Website www.bajajallianz.com

Corporate Identification Number: U66010PN2000PLC015329 | Demystify Insurance https://www.bajajallianz.com/blog.html

http://www.facebook.com/BajajAllianz http://twitter.com/BajajAllianz https://www.linkedin.com/company/bajaj-allianz-general-insurance