-

NATIONALINSURANCECOMPANY LTD.
(9TO T U 3H)
TT a y 3. fR z, E National Insurance (A Govt. of India Undertaking) Kolkata-700 071
E a7 43, .
700 071 Head Office:3, Middleton Street,
, Hegd.& S. N. Banerjee
Hoad,
Barrackpore Branch Office 43,
TFBI 700 120
74T: 033-2592-0146, 2593 5030 Barrackpore, Kolkata 700 120
Phone:033-25920146,25935030

POL ICY SCHE DULE

1

Policye: iS459i/48/13/859p0615 - --

ospitalisation beeefit Pelie ledividal Mediclaia

Ageet Code: il74588
Ageat Mane: ASIN KUM SIKDAR
Agent Contaet o: 9432311164
Previees Policy Year /o :?92/ 1545414812854040i929
iseree s Wae: SUEiR GRISH. Dev officer 15450
Address Isseing office: Unit 154581
BAGCHI PARA Addr ess Atiedra Coepler, 87/28, Ghosh
,

bist. er th 24
EOAB,P.0. NOM CHAMBAN PUKUR. Para teed, larr
Parganas, West dengal
lelephone :033 2592 146
Pie Code: 780122 2593 5939 Fa:
Peiicy Per iod: b:0 on 29/87/2013 ie kidnight of
19/07/2014 Receiot date & No.
et Prei: ks.z,¬70 EUPEES TO THOUSABA SIX HUNOREO SEVENTY ONLY
:
44/0i/10i3 i545ül/äi/13/00i940531
-----
beteils of the TkSUREt Andjöther faniiy Meebers
-~--------.
kesiding vith the INSUREO If Covered 02/13

Subject to exclusion
CU. Bon.of
pre-existing diseases
e ae ef the iesered Saa Aeount
entioned belov
per soes kgei Sex Occepetion i Relation! Preniunl insared i iinception
----------
bate
SEI 6HÜSH. 3ei Service iSelf ,371 i id0,d00 i 20,d00 NORMAL POLICY
EXCLUSION
2MUSU HISH 24iF iHoesevifeltife .049 i 100,04 i 20,000 NORMAL POLICY
EXCLUSTON +GALL
8LO0BER PRO8LEN
JULY-2008(0R.
PURNENDU ROY, GENESES
HOSPITAL. KOL.}
AHTITAI HCSH i i ilnfant ibaughter 54i 50,04 S,060 NORMAL POLICY
EXCLUSTON(NE
INCLUDED W.E,E
20.1.2011
Pr otosal fore and beciaration bated 24/07/2009 Cap 0isc :0
Totel basic Preniue: ks.i. 967 Faeily tiscount: ks.297
Net Premiu Rs.2.670
ASsignee Nase Service Tax Rs.334
MOISUNI GHS
--------~-----
Total is. 3,4
6 IRESS vHEREOE, the uedersigned beiag duly authorised hereunto set his hand at 43,5. N. BANERJEE this 04th Jul. 201s
*IS Surence shali! not extend to pay
any expenses incurred relating to
the diseaselsi/sickeess/injury
eentioned in thís coluan and for consequences For and oa behaif of
attributaoie thereto or acclerated taereby or arising therefron. National Insarance Coapaay Liaited

Bar ackore B COAilc

Authorised Signatory
er increasing $I aore than 2/3 slab ihe vaiting periods as in exclusions 4 b / o the policy shall apply ot e
ced S as if it is a tev policy. The benefit shail accrue for PEü or vaiting period diseases once the policy vith
ethanced Si cOapletes the vaiting period noted in the policy for these diseases.
Beraiis df a r e as given beio«: 022869 :C
OHE u ed Save Heaith Care TPA itd
 MATIONAL INSURANCE COMPANY LT0
7 afionel sUraNce

461 /48/12/98618
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