HDFC ERGO General Insurance Company Limited
Certificate of Insurance 2855205282849100000
Sarv Suraksha Plus (Group)
2855205282849100000
MR SUBHAM SINGH
SO RAJESH PRATAP SINGH
BAHADURPUR
DHANOULI
GONDA, UTTAR PRADESH, 271403
Contact No. 6393433977
Date :08/03/2023
Dear MR SUBHAM SINGH
Thank you for choosing HDFC ERGO as your preferred insurance partner.We welcome you to be a part of our family!
Your coverage of insurance under the Sarv Suraksha Plus (Group) policy reference no 2855205282849100000 i s confirmed on the basis of the information and declaration
provided by you.
The details of coverage are mentioned in the enclosed certificate of insurance.
We value your relationship with us and assure you our best services at all times and we look forward to serve you.
This certificate of insurance can be renewed subject to outstanding loan tenure and loan amount at the expiry of the certificate, Please contact HDFC ERGO General Insurance
company limited for renewal.
For HDFC ERGO General Insurance Company Ltd.
Authorized Signature
HDFC ERGO General Insurance Company Limited
Tax Certificate
Dear MR SUBHAM SINGH,
Subject : Certificate for the purpose of deduction under section 80 D of Income Tax (Amendment) Act, 1986
This i s to certify that we have received an amount of` 68 towards premium for Sarv Suraksha Plus (Group), Certificate No. 2855205282849100000 issued to MR
SUBHAM SINGH for the period 06/03/2023 to 05/03/2024.
Note : This is subject to the provisions of Section 80D of income tax (Amendment) Act, 1986 as amended from time to time.
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 : 08/03/2023
Policy issuance office : Mumbai
Duly Constituted Attorney
HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN : HDFHLGP21002V022122. Customer Service Address: D 301, 3rd Floor,
CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078.
165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service No : +91 22-62346234/+91-120 6234 6234 | www.hdfcergo.com
HDFC ERGO General Insurance Company Limited
Certificate of Insurance 2855205282849100000
Sarv Suraksha Plus (Group)
2855205282849100000
Certificate No. :2855 2052 8284 9100 000 Issuance Date : 08/03/2023
Period of Insurance : From 06/03/2023 12:13 hrs To 05/03/2024 Midnight
Invoice No. :205282849100000 Premium Frequency :Single
Proposer Name :Mr Subham Singh
MR SUBHAM SINGH HSN Code :997133 eIA :Not provided
SO RAJESH PRATAP SINGH Customer Id :1013911220570002 Loan Sanction Amount :15499
BAHADURPUR Master Policy No. :2999205101887400000
DHANOULI
GONDA, UTTAR PRADESH, 271403 Master Policy Holder :HDFC BANK LIMITED
Contact No. 6393433977 Name
Loan Account No. :457063691
Lending Institution :HDFC BANK LTD
Email ID :subhamsingh7800@gmail.com
Payment Details : 457063691 EMI PROTECT-HDFC ERGO , Date: 06/03/2023, Bank Name:HDFC Bank Ltd
Insured Person Details
Name of Relation with 1st Policy
Group member ID Gender DOB Sum Insured
Insured Person policy holder* Inception
SUBHAM SINGH 2023310025870501 Applicant Male 17/09/1998 06/03/2023 75000
*Relationship is relation of Insured with policyholder
Nominee Details
Nominee Name Nominee Relationship Appointee Name Appointee Relationship
Legal heir others
Schedule of Coverage
Co-payment /
Insured Name Coverages Sub Coverages Base Sum Insured Sum Insured Deductible/
Excess
Accidental Hospitalization Expenses
Accidental Hospitalization Expenses 25000 25000 0
(India)
Accident Death 50000 50000 0
SUBHAM SINGH
Comatose 25000 25000 0
Personal Accident
Disappearance 50000 50000 0
Permanent Disablement (Table B) 50000 50000 0
Premium Details (`)
Particulars SUBHAM SINGH
Base Premium (A) 77.43
Optional Cover Premium (B) 0
Medical Underwriting Loading (C) 0
Total Premium (D=A+B+C) 77.43
Discounts (E) 0
Goods & Service Tax (GST) (F) 14
Gross Premium (G) 77
Grand Total - Premium excluding GST (H) 77
Grand Total - Premium including GST (I) 91
For Claim/Policy related queries call us at +91- 22 6234 6234/+91- 120 6234 6234 or Visit Help Section on www.hdfcergo.com for policy copy/tax certificate/make changes/register &
track claim.
If the premium is not realised the policy shall be void from inception.Consolidated stamp duty for this Insurance Policy is paid by Demand Draft, vide Receipt/Challan noNO.LOA/CSD/477/2022/4252 dated
29/09/2022 as prescribed in Government of Maharashtra Order No. Mudrank-2017/CR.97/M-1, dated the 09th January 2018. Goods & Services Tax Registration No: 27AABCL5045N1Z8GST for this invoice is not
payable under reverse charge basis. I/ 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
Branch :leela business park, 6th flr, andheri - kurla rd, mumbai
For HDFC ERGO General Insurance Company Ltd.
Agent Name : HDFC BANK LTD
Agent Code : 201587086428 Tel No. : 91-22-61606161
Duly Constituted Attorney
For detailed policy terms and conditions please visit our website https://www.hdfcergo.com/download/policy-wordings
HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN : HDFHLGP21002V022122. Customer Service Address: D 301, 3rd Floor,
CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078.
165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service No : +91 22-62346234/+91-120 6234 6234 | www.hdfcergo.com
HDFC ERGO General Insurance Company Limited
2855205282849100000
HDFC ERGO General Insurance Company Limited 1
Policy No.:2855205282849100000 This card is for identification purpose only.
Valid From: 06/03/2023 Renewal Date: 5 March
Card has to be presented to the Network Service Provider at the time of admission/ availing
Insured Name Date Of Birth Gender cashless hospitalization o r any other services. Insurance claim will be processed in accordance
with the policy term & conditions. Card does not guarantee cashless hospitalization or any other
service. For more details and updated list of Network Service Provider please refer our website or
SUBHAM SINGH 17/09/1998 Male call our call centre. This card is valid till the time policy is active.
Customer Service No : 022 - 6234 6234 / 0120 - 6234 6234
:
Email : healthclaims@hdfcergo.com
Processing Centre : HDFC ERGO General Insurance Company Ltd. 5th
floor,Tower 1, Steller IT Park, C-25,
Sector-62,Noida-201301.
Website : www.hdfcergo.com
HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN : HDFHLGP21002V022122. Customer Service Address: D 301, 3rd Floor,
CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078.
165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service No : +91 22-62346234/+91-120 6234 6234 | www.hdfcergo.com
