24-Dec-2019

Mr Ram Kumar Policy No.: 110100/12001/2019/A015317-01

Jastech Systems Private Limited
Plot-258, Sector-8,
IMT Manesar
Gurgaon - 122052
Haryana
India

Easy Health Group Insurance

Dear Mr Ram Kumar,

Welcome to the Apollo Munich Health family and thank you for insuring your Members and their Dependents
with us.

With reference to the Easy Health Group Insurance Cover from Apollo Munich Health, we are pleased to
enclose the policy documents along with the Unique Policy Number.

We would be happy to address any query your beneficiaries may have on our 24 hours toll free number as
mentioned below. The Cashless Insurance Cards (for all eligible / covered medical expenses for each
beneficiary covered under the policy) will reach you shortly. To serve you better, we request your beneficiaries
to indicate their Unique Member Card Number during all future correspondence with us.

Thank You!

Warm Regards,

Authorized Signatory

Enclosure:
1. Policy Schedule
2. Memorandum
3. List of Insured Persons
4. Policy Wordings

Toll Free No: - 1800-102-0333

Intermediary Name Intermediary Code Intermediary Contact Number

SANJAY JAIN 89046306 9810505080
 Easy Health Group Insurance - POLICY SCHEDULE

Issuing Office: Jhandewalan Branch Office,1st Floor, 2E/25, Jhandewalan

Extension,Jhandewalan,,New Delhi,Delhi-110005,PH :
01143585333
GSTIN: 07AAGCA1654H1ZU

Intermediary Code: 89046306

Policyholder's Name: Jastech Systems Private Limited

GSTIN/ UIN (If any) of Policy Holder 06AACCJ8842Q1ZW

Policyholder's Address: Plot-258, Sector-8,

IMT Manesar
Gurgaon - 122052
Haryana
India

Policy Holder's State/UT Name & Code: Haryana(06)

Policy Number: 110100/12001/2019/A015317-01

First Policy Inception Date: 08-Dec-2019

Policy Issuance Date 24-Dec-2019

From 00.00 hrs on 08-Dec-2019 To 24.00 hrs on 07-Dec-2020

Total Number of Primary Insureds: 39

Total Number of Dependents: 50
Total Number of Insured Persons: 89

Total Sum Insured: (Rs)4100000

Coverage Basic Health Cover

Description/ Harmonized System of Nomenclature code Accident And Health Insurance Services/9971
Place of Supply: Gurgaon (Haryana)
Additional Conditions / Exclusions (if any):
Category Exclusion Code Details
Jastech Systems Private Limited 100 K 2C 1st year exclusion waived for all
2B 30 days waiting period waived for all members.
2D PE exclusion waived for all.
Jastech Systems Private Limited 200 K 2D PE exclusion waived for all.
2B 30 days waiting period waived for all members.
2C 1st year exclusion waived for all
Jastech Systems Private Limited 200 K 2D PE exclusion waived for all.
2B 30 days waiting period waived for all members.
2C 1st year exclusion waived for all
Premium Calculation:
Net Premium (Rs) 149715.83
Taxable Premium (Rs) 149715.83
CGST@9% (Rs) 0.00
SGST / UTGST @9% (Rs) 0.00
IGST @18% (Rs) 26948.85
Any other Cess or Taxes (Rs) 0.00
Gross Premium (Rs) 176664.68
Gross Premium Amount (in words) Rupees One Lakh Seventy-Six Thousand Six Hundred Sixty-
Four and Paisa Sixty-Eight Only
The stamp duty of Rs 1.00/- (Rupees One Only) paid vide e-stamp Certificate No. IN-DL-
DL42844961502751O. (Not applicable for the state of Jammu & Kashmir).
Original for Recipient/ Duplicate for Supplier
Whether tax is payable on reverse charge basis No
TPA Name: Family Health Plan (TPA) Ltd (L.No.13)

Location:
TPA Gurgaon For and on behalf of Apollo Munich Health Insurance Company Limited
Date: 24-Dec-2019

Authorized Signatory
 Annexure: List of Insured Persons
Policy Number : 110100/12001/2019/A015317-01
Total number of Primary insured: 39
Total number of Dependents: 50
Total number of Insured members: 89

Employee Id
/ Sum Insured Risk Inception
S. No Customer Id Primary Insured's Name Dependent Name Relationship Gender Age (Rs) Date
1 1001 Mr Amit Kumar Self Male 29 100000 08-Dec-2019
2 1001 Mr Amit Kumar Ms Laxmi Devi Wife Female 28 08-Dec-2019
3 1001 Mr Amit Kumar Ms Akshita Child Female 0 08-Dec-2019
4 1002 Mr Ashok Sharma Self Male 30 100000 08-Dec-2019
5 1002 Mr Ashok Sharma Ms Bhavika Child Female 4 08-Dec-2019
6 1002 Mr Ashok Sharma Ms Sonu Sharma Husband Female 27 08-Dec-2019
7 1004 Mr Bhuwan Bhaskar Self Male 34 100000 08-Dec-2019
8 1004 Mr Bhuwan Bhaskar Mr Divyank Child Male 2 08-Dec-2019
9 1004 Mr Bhuwan Bhaskar Ms Renu Wife Female 28 08-Dec-2019
10 1006 Mr Harvinder Singh Self Male 53 100000 08-Dec-2019
11 1006 Mr Harvinder Singh Ms Navleen Kaur Child Female 24 08-Dec-2019
12 1006 Mr Harvinder Singh Ms Gurpreet Kaur Wife Female 41 08-Dec-2019
13 1006 Mr Harvinder Singh Mr Manpreet Singh Child Male 19 08-Dec-2019
14 1006 Mr Harvinder Singh Ms Jaspreet Kaur Child Female 21 08-Dec-2019
15 1007 Mr Jagdish Chander Self Male 50 100000 08-Dec-2019
16 1007 Mr Jagdish Chander Ms Tanya Child Female 19 08-Dec-2019
17 1007 Mr Jagdish Chander Ms Sharda Devi Wife Female 49 08-Dec-2019
18 1007 Mr Jagdish Chander Ms Payal Child Female 16 08-Dec-2019
19 1007 Mr Jagdish Chander Mr Keshav Child Male 13 08-Dec-2019
20 1009 Ms Kanchan Bala Self Female 28 100000 08-Dec-2019
21 1010 Mr Kusumakar Tripathi Self Male 51 100000 08-Dec-2019
22 1010 Mr Kusumakar Tripathi Ms Mansi Tripathi Child Female 21 08-Dec-2019
23 1010 Mr Kusumakar Tripathi Ms Vandna Tripathi Wife Female 48 08-Dec-2019
24 1010 Mr Kusumakar Tripathi Mr Pratyush Child Male 14 08-Dec-2019
25 1011 Mr Nand Lal Rajbhar Self Male 46 100000 08-Dec-2019
26 1011 Mr Nand Lal Rajbhar Ms Vinita Kumari Child Female 10 08-Dec-2019
27 1011 Mr Nand Lal Rajbhar Ms Malti Devi Wife Female 40 08-Dec-2019
28 1011 Mr Nand Lal Rajbhar Mr Vivek Rajbhar Child Male 15 08-Dec-2019
29 1011 Mr Nand Lal Rajbhar Mr Vinay Kumar Child Male 7 08-Dec-2019
Rajbhar
30 1012 Ms Nidhi Singh Self Female 27 100000 08-Dec-2019
31 1013 Mr Nishu Sharma Self Male 28 100000 08-Dec-2019
32 1013 Mr Nishu Sharma Ms Arohi Sharma Child Female 6 08-Dec-2019
33 1013 Mr Nishu Sharma Ms Parul Sharma Wife Female 25 08-Dec-2019
34 1014 Mr Punit Kumar Self Male 33 100000 08-Dec-2019
35 1014 Mr Punit Kumar Ms Arohi Child Female 2 08-Dec-2019
36 1014 Mr Punit Kumar Ms Alka Wife Female 29 08-Dec-2019
37 1014 Mr Punit Kumar Mr Vansh Child Male 7 08-Dec-2019
38 1016 Mr Rahul Mishra Self Male 27 100000 08-Dec-2019
39 1016 Mr Rahul Mishra Ms Laxmi Devi Wife Female 23 08-Dec-2019
40 1016 Mr Rahul Mishra Mr Rudransh Child Male 0 08-Dec-2019
41 1017 Mr Ram Kumar Self Male 30 100000 08-Dec-2019
42 1017 Mr Ram Kumar Ms Kumari Sakshi Child Female 9 08-Dec-2019
43 1017 Mr Ram Kumar Ms Babeeta Wife Female 33 08-Dec-2019
44 1017 Mr Ram Kumar Mr Om Kumar Child Male 13 08-Dec-2019

110100/12001/2019/A015317-01
 Employee Id
/ Sum Insured Risk Inception
S. No Customer Id Primary Insured's Name Dependent Name Relationship Gender Age (Rs) Date
45 1018 Mr Sachin Ahlawat Self Male 31 100000 08-Dec-2019
46 1018 Mr Sachin Ahlawat Ms Meenakshi Wife Female 32 08-Dec-2019
47 1018 Mr Sachin Ahlawat Ms Mayra Ahlawat Child Female 1 08-Dec-2019
48 1020 Mr Satypal Sinhmar Self Male 30 100000 08-Dec-2019
49 1020 Mr Satypal Sinhmar Ms Aaneya Chaudhary Child Female 4 08-Dec-2019
50 1020 Mr Satypal Sinhmar Ms Neha Rani Wife Female 28 08-Dec-2019
51 1022 Mr Surendra Singh Self Male 44 100000 08-Dec-2019
Chauhan
52 1022 Mr Surendra Singh Mr Prithviraj Singh Child Male 17 08-Dec-2019
Chauhan Chauhan
53 1022 Mr Surendra Singh Ms Manju Devi Wife Female 39 08-Dec-2019
Chauhan
54 1022 Mr Surendra Singh Mr Devraj Singh Child Male 20 08-Dec-2019
Chauhan Chauhan
55 1023 Mr Vikas Chauhan Self Male 29 100000 08-Dec-2019
56 1023 Mr Vikas Chauhan Ms Vanshika Child Female 4 08-Dec-2019
57 1023 Mr Vikas Chauhan Ms Meena Devi Wife Female 28 08-Dec-2019
58 1023 Mr Vikas Chauhan Ms Manishka Child Female 0 08-Dec-2019
59 1024 Mr Tasnim Quaisar Self Male 29 100000 08-Dec-2019
60 1025 Mr Sandeep Kumar Self Male 28 100000 08-Dec-2019
Sharma
61 1025 Mr Sandeep Kumar Ms Shalu Kumari Wife Female 25 08-Dec-2019
Sharma
62 1026 Mr Subhash Sharma Self Male 26 100000 08-Dec-2019
63 1027 Mr Mohit Kumar Self Male 27 100000 08-Dec-2019
64 1028 Mr Jang Bahadur Roy Self Male 39 100000 08-Dec-2019
65 1028 Mr Jang Bahadur Roy Ms Komal Kumari Child Female 16 08-Dec-2019
66 1028 Mr Jang Bahadur Roy Ms Mala Devi Wife Female 34 08-Dec-2019
67 1028 Mr Jang Bahadur Roy Mr Sonu Kumar Child Male 15 08-Dec-2019
68 1028 Mr Jang Bahadur Roy Ms Sonam Kumari Child Female 10 08-Dec-2019
69 1028 Mr Jang Bahadur Roy Ms Sonali Kumari Child Female 8 08-Dec-2019
70 1032 Mr Ashish Self Male 23 100000 08-Dec-2019
71 1034 Mr Mohit Self Male 28 100000 08-Dec-2019
72 1034 Mr Mohit Ms Geeta Wife Female 26 08-Dec-2019
73 1037 Mr Jitender Singh Bisla Self Male 53 200000 08-Dec-2019
74 1038 Mr Satya Narayan Self Male 52 200000 08-Dec-2019
75 1035 Mr Siddhant Singh Bisla Self Male 27 100000 08-Dec-2019
76 1036 Mr Nirvesh Self Male 38 100000 08-Dec-2019
77 1039 Mr Anoop Tripathi Self Male 49 100000 08-Dec-2019
78 100006 Mr Rakesh Kumar Self Male 44 100000 08-Dec-2019
79 100007 Mr Goutam Pramanik Self Male 37 100000 08-Dec-2019
80 100008 Mr Amit Chowdhry Self Male 52 100000 08-Dec-2019
81 100002 Mr Krishan Kant Self Male 24 100000 08-Dec-2019
Choudhary
82 100003 Mr Ahmad Faraz Siddiqui Self Male 24 100000 08-Dec-2019
83 100004 Mr Akash Sain Self Male 21 100000 08-Dec-2019
84 100005 Mr Sunil Kumar Sain Self Male 32 100000 08-Dec-2019
85 100001 Mr Deepak Yadav Self Male 26 100000 08-Dec-2019
86 100001 Mr Deepak Yadav Ms Monika Wife Female 22 08-Dec-2019
87 100009 Mr Nitin Kumar Rohela Self Male 32 100000 08-Dec-2019
88 100009 Mr Nitin Kumar Rohela Ms Priyanka Rohilla Wife Female 26 08-Dec-2019

110100/12001/2019/A015317-01
 Employee Id
/ Sum Insured Risk Inception
S. No Customer Id Primary Insured's Name Dependent Name Relationship Gender Age (Rs) Date
89 100010 Ms Sarika Sharma Self Female 43 100000 08-Dec-2019

110100/12001/2019/A015317-01