Policy Certificate: 92789 State Bank of India 122665616

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Policy Certificate

Pranesh Gopalrao Zalkikar


mangal murti nagar jagannath mandir, room no 102 bldg no 2
Dandi
Tarapur, 401501
Maharashtra

Intermediary 92789 Intermediary Name: STATE BANK OF INDIA Certificate No. 122665616

Date: 03/04/2019 This is to certify that


Pranesh Gopalrao Zalkikar

is insured for an amount of INR 400000 /- , under Personal Accident Policy subject to exclusions, provisions and
other terms as specified in Master Policy No.122665616 for a period of 1 year from 03/04/2019

Nominee : pragati zalkikar Relationship Spouse


:
Name with

Proposal Ref.
SBI Account No.: 30942838426

Premium received: 200


INR 200/- inclusive of tax as applicable
Authorised Signatory

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