mahesh policy

7/29/2019 Mahesh Policy

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FAMILY HEALTH OPTIMA INSURANCE POLICY - SCHEDULE

P/700002/01/2013/011352Policy No. Previous Policy No. ::

700002Issuing Office Code :

RAMDAS PETH,NAGPUR

NAGPUR

Address :

NAGPUR - 440010, Maharashtra

566/A,OPPOSITE GRIHINI SAMAJSCHOOL,

9890070945/Phone No : 1800-425-2255:

E-mail id [email protected]:: 05/03/2013 Fulfiller Code SO700002:

NEW

Receipt No : 1272012061

Premium 5,555.00: Rs 687.00Service Tax : Rs

1.00 6,242.00Stamp Duty Total Premium: Re : Rs

Total Premium In Words : Rupees Six Thousand Two Hundred Forty-Two Only

PERIOD OF INSURANCE

SCHEME - DESCRIPTION : 2 ADULTS + 1 CHILD

Details of Insured Persons :

Sl.No.

Name of the Insured ID Card NoSex Relationship withProposer

Date of Birth Age-Yrs/Mths Pre Existing Disease/s

1

2

3

MAHESH RAJARAMSHUKLA

ANSHUMA MAHESHSHUKLA

HARSHWARDHANMAHESH SHUKLA

MALE

FEMALE

MALE

SELF

SPOUSE

DEPENDANTCHILD

18/05/1973

15/06/1975

18/08/2010

39 Yrs 9 Mths

37 Yrs 8 Mths

2 Yrs 6 Mths

2763763-1

2763763-2

2763763-3

NIL

NIL

NIL

: 05/03/2013

Renewal Year :

E-mail id : NIL

Phone No : /

: TeleSales

: OL0000000002Intermediary Code

Name

Warranted that in case of dishonor of premium cheque(s), the Company shall not be liable under the policy and the policy shall be void abinitio(from inception).

THE INSURANCE UNDER THIS POLICY IS SUBJECT TO CONDITIONS, CLAUSES, WARRANTIES, EXCLUSIONS ETC., ATTACHED.

IMPORTANT

IN THE EVENT OF HOSPITALIZATION OF INSURED PERSON, INTIMATION SHOULD BE GIVEN TO THE COMPANY IMMEDIATELY,

Sector : None

FROM : :TO06/03/2013 00:00:00 Midnight Of 05/03/2014

Address :

Opp. Andheri Railway Station,

No: 7/8, Sneh Samadan, Sahar Road,

ONLINE BUSINESS

E-mail id : [email protected]

Proposer's Code 2763763:

Proposer's Name MAHESH RAJARAM SHUKLA:

Andheri - East, Mumbai - 400 069

Issuing Office Name Online Business:

Toll Free No

Expenses relating to the hospitalisation will be in proportion to the room rent stated in the policy.

Date of Inception of first policy : 06/03/2013

Proposal date

Receipt Date

/-/-

/- /-

:Bonus

BASIC FLOATER SUM INSURED : Rs.

LIMIT OF COVERAGE : 300000 /-Rs.

300000 /-

/-Rs.

( Three Lakhs Only)


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Attached to and forming part of Policy No. P/700002/01/2013/011352

It is hereby declared and agreed that

Point No 1.0 (A) appearing in the policy shall read as follows:

Room, Boarding expenses as provided by the Hospital / Nursing Home at:

2% of the Sum Insured, subject to a maximum of Rs.5,000/- per day in Class "A" Cities,

1% of the Sum Insured, subject to a maximum of Rs.3,000/- per day in Class "B" Cities and

1% of the Sum Insured, subject to a maximum of Rs.1,000/- per day in other locations.Further the definition of Class A and Class B cities mentioned in the policy stands amended as follows:

Class "A" cities meansAhmedabad, Bangalore, Chennai, Hyderabad including Secunderabad, Kolkata, Mumbai including Thane, Pune , New Delhi including Noida,Gurgaon,Faridabad and Ghaziabad

Class "B" cities means

Agra, Baroda, Coimbatore, Cochin, Indore, Kanpur, Ludhiana, Surat, Meerut, Jalandhar, Amritsar , Nagpur and All State Capitals other than

those falling under Class "A".

Other Locations means

Rest of India not falling under Class A and Class B above.

All other terms and conditions of the policy remain unaltered.


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This is to certify that MAHESH RAJARAM SHUKLA has paid Rs 6242 (Total Premium In Words : Indian Rupees SixThousand Two Hundred Forty-Two Only ) towards Premium for Hospitalization Insurance vide Policy No:P/700002/01/2013/011352 for the Period 06-MAR-13 To 05-MAR-14 issued on 05-MAR-13 .Payment received by Cheque/Credit/Debit Card vide collection No: 1272012061 - 05/03/2013

Premium Certificate for the purpose of deduction under Section 80 D of Income Tax (Amendment) Act,1986

700002 - Online BusinessIssue Office

Hospitalisation Benefit Policy

P/700002/01/2013/011352Policy No

Note :- This Certificate must be surrendred to the Insurance Company for issuance of fresh Certificate in case of Cancellationof the Policy or any alteration in the Insurance affecting the Premium.

FHO-PolicyType Of Policy :

For Star Health and Allied Insurance Company Ltd.

Authorised Signatory

:

:

Email [email protected]:

1800-425-2255Toll Free No :

No: 7/8, Sneh Samadan, Sahar Road,

Opp. Andheri Railway Station,

Address

Andheri - East, Mumbai - 400 069

:


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Name MAHESH RAJARAM SHUKLA

Date of Birth Age18/05/1973 39 Years

Gender M

Valid From 06/03/2013

Office Code 700002

Emergency Help Line No. 1800 425 2255 / 044 2826 3300E-mail: [email protected] Website: www.starhealth.in

Please quote the Customer ID No. for assistance

Immediate intimation to Star through above Telephone number is a mustin the case of Hospitalisation.

This card to be produced at the time of Hospitalization along with the validphoto identity proof.

This ID card is invalid, if the insurance cover is not in force.

This card is valid until otherwise cancelled.

Star Health and Allied Insurance Company LimitedCustomer Identity Card

Personal and Caring

Customer ID No. 2763763-1:

:

:

:

:

:

:


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Name ANSHUMA MAHESH SHUKLA


Gender F


Office Code 700002








Personal and Caring


:

:

:

:

:

:


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Name HARSHWARDHAN MAHESH SHUKLA


Gender M


Office Code 700002








Personal and Caring


:

:

:

:

:

:

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