HDFC ERGO General Insurance Company Limited
2866204523649400001
my 4 0
Mr Mr Sunil Kushwaha
Kushalpal Singh Amkawalon Ki Kothi Nyaderganjgiti Rd
Dadri Gautam Budh Ngr Achheja,Next To Sugan
Furniture Gautam Buddha Nagar
Uttar Pradesh, 203207
Contact No : 96XXXXXXX0
Dear Mr Sunil Kushwaha
Thank you for choosing HDFC ERGO as your preferred insurance partner. We welcome you to be a part of our family !
Your Health insurance policy reference no 2866204523649400001 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.
We value your relationship with us and assure you our best services at all times and we look forward to serve you.
Now you can view your policy details and health card at your fingertips. Download our Mobile App now and experience convenience today!!
Proposer details have been updated basis the information present in the KYC documents. If you find any detail which needs to be corrected, request you to create/ modify the
eKYC ID and place a request for endorsement.
Soft copy of the policy is valid for all purposes including claims.
For HDFC ERGO General Insurance Company Limited
Arun Sharma
Head - Customer Experience Management
HDFC ERGO General Insurance Company Limited
TAX CERTIFICATE
Dear Mr Sunil Kushwaha,
Subject : Certificate for the purpose of deduction under section 80 D of Income Tax (Amendment) Act, 1986
Note: This is subject to the provisions of Section 80D of income tax (Amendment) Act, 1986 as amended from time to time.
For HDFC ERGO General Insurance Company Limited
Date : 19/02/2022
Policy Issuing Office: Mumbai Duly Constituted Attorney
HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 HDFHLIP22021V042122. 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 2866204523649400001
Policy Schedule - Endorsed Copy
my: health Medisure Super Top Up Insurance
2866204523649400001
Policy No. : 2866 2045 2364 9400 001 Issuance Date : 18/01/2023 1
Period of Insurance : From 19/02/2022 10:46 hrs hrs To 18/02/2024 Midnight
Invoice No. : 204523649400001 Premium Frequency : Single
Mr Mr Sunil Kushwaha
Kushalpal Singh Amkawalon Ki Kothi Nyaderganjgiti Rd Dadri Proposer Name : Mr Mr Sunil Kushwaha Policy Type : Family floater
Gautam Budh Ngr Achheja,Next To Sugan Furniture Gautam HSN Code : 997133
Buddha Nagar Customer Id : 100990595258
Uttar Pradesh, 203207
PAN No.
Contact No : 96XXXXXXX0
EIA No. : Not provided
Email ID : kuxxxxxxxxx70@yxxxx.com
Insured Person’s Details & Sum Insured
Insured's Name Relation with Gender Date of Nominee Name Nominee 1st Policy Sum Insured Deductible Pre Existing
policy holder Birth Relationship Inception (`) (`) Disease
Mr Sunil Kushwaha Self Male 01/03/1966 Vaishali Spouse 19/02/2022 No
1600000 400000
Vaishali Spouse Female 10/06/1983 Sunil Kushwaha Spouse 19/02/2022 No
Premium Details (`)
Basic Premium 13200.00
Total Premium excluding Taxes 13200.00
Additional Loading 0.00
Policy tenure Discount 660.00
Tax as Applicable 2257.00
Total Premium 14797.00
For declared and accepted pre-exiting medical conditions, waiting period (s) shall apply per policy terms and conditions from 1st policy inception date of the policy, fresh
waiting period (s) shall apply on enhanced sum insured.
Endt No List of Endorsements Description Effective Date
001 Correction in insured particulars 19/02/2022
Processing Centre HDFC ERGO General Insurance Company Ltd. 5th floor, Tower 1, Steller IT Park, C-25, Sector-62,Noida-201301.
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.
I f the premium i s 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/ENF-1/CSD/34/2023/6045 dated
27/12/2023 a s prescribed in Government of Maharashtra Order No. Mudrank-2017/CR.97/M-1, dated the 09th January 2018;. . GST Registration No: 27AABCL5045N1Z8. GST 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 :4th floor, lake city mall kapurbavadi junction,majiwada naka,thane (w) thane
Broker Name : KRISHIV INSURANCE BROKING LLP For HDFC ERGO General Insurance Company Ltd
Broker Code : 201064075517
Duly Constituted Attorney
Scan the code for Instant Policy Info, Register/Track Claim, Renewal and Modifications in policy.
"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 HDFHLIP22021V042122. 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 2
Policy No.:2866204523649400001 This card is for identification purpose only.
Valid From: 19/02/2022 Renewal Date: 18 February
Card has to be presented to the Network Service Provider at the time of admission/ availing
cashless hospitalization o r any other services. Insurance claim will be processed in accordance with
Insured Name Member ID Date Of Birth Gender 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 call our call
MR SUNIL KUSHWAHA 2022210014888683 01/03/1966 Male centre. This card is valid till the time policy is active.
Vaishali 2022210014888684 10/06/1983 Female 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 HDFHLIP22021V042122. 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
