THE NEW INDIA ASSURANCE CO. LTD.

(Government of India Undertaking)

THE NEW INDIA ASSURANCE CO. LTD.

REGISTERED & HEAD OFFICE:87,MAHATMA GANDHI ROAD,MUMBAI
400001

Customer ID : ME01190470

New India Mediclaim POLICY

SCHEDULE

Insureds Details Issuing Office Details

Insured Name : MRS ANURADHA A GADRE Office Code : GHATKOPAR D.O. (140600)
Address : B-15-16, RAJHANS CHS, HANS NAGAR, Address : GHATKOPAR D.O. 3RD FLOOR, JYOTI
BH S T WORKSHOP, THANE (W) CHAMBERS, J V ROAD, KHOT LANE,
GHATKOPAR (W)

THANE ,MAHARASHTRA, 400601 ,400086

Phone No/Mobile No. : Phone No : 25102695 / 25165894
E-mail/Fax : / E-mail/Fax : nia.140600@newindia.co.in / 25102774
PAN No : S.Tax Regn. No : AAACN4165CST178
GSTIN/UIN : NA / NA GSTIN : 27AAACN4165C3ZP
: SAC : 997139 (Other non-life insurance services
excl RI)

Policy Details
Business Source Code
Policy Number : 14060034189500007006 Dev.Off : DIRECT BUSINESS NA NA
level./Broker/Direct (2D6490881)
Period of Insurance : From:11/11/2018 12:00:01 AM Agent/Bancassurance : Mr. ANIL P GAONKAR (2D6490529)
To:10/11/2019 11:59:59 PM
Prev. Policy no. : 14060034179500003647 Phone No : 9820771278, 9820771278 / NA
Client Type : Non-Corporate E-mail/Fax : / / /

Insured Person Details

Sl. No. Name of Date of Birth Sex Occupation Relation Pre-Existing Disease Sum Insured Cumulative
Insured Bonus Buffer
Person
1 MRS 30/05/1952 F Housewiv Proposer NA 200000 80000
ANURADHA A es
GADRE

Details Of TPA for New India Mediclaim Policy (Notice or Communication to be given in respect of claim)
Name : MDINDIA HEALTH INSURANCE TPA Telephone : 02025300000
PVT. LIMITED
Address : S. NO. 46/1, E-SPACE, A-2 BUILDING, Fax : 02025300003
3RD FLOOR, PUNE-NAGAR ROAD, Email :
VADGAONSHERI, PUNE-411014 Toll Free No. :
NA Mobile No. :

Name of Nominee : MR AVINASH Y GADRE Relation : Spouse

Optional Cover Table

Sl. Name of the person Optional Cover I - No Optional Cover II- Maternity Optional Cover III- Revision Optional Cover
No. Proportionate Deduction Expenses Benefit (Sum in Cataract Limit IV- Voluntary
Insured): Co-pay

1 MRS ANURADHA A Not Opted Not Opted NA Not Opted NA Not Opted
GADRE

Previous Policy Details

Signature Not
Verified
Digitally signed
by Srinivasan
Vaideswaran
Date: 2018.11.10
17:04:13 IST
Policy No. : 14060034189500007006Document generated by 20050 at 10/11/2018 17:04:12 Hours.
Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.

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THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

Sl. No. Name of Insured Previous Policy No. Previous Sum Cumulativ Effective Pre-existing Disease
Insured details e bonus Date
buffer
1 MRS ANURADHA A GADRE 140600341795000036 200000 80000 11/11/200 NA
47 0

Sl. Name of Insured Basic Premium Premium for Optional Premium for Prem Discount for Total
No. Cover I Optional ium Optional Premium
Cover II for Cover IV
Optio
nal
Cove
r III
1 NA 0 0 0 0 0 0
2 MRS ANURADHA A 22800 0 0 0 0 22800
GADRE
Total Premium 22800
GST 4104
Total Amount 26904
Net Premium Amt.(In words) RUPEES TWENTY-SIX
THOUSAND NINE HUNDRED
FOUR ONLY

*This Policy is subject to terms and conditions of New India Mediclaim.

Premium and GST Details

Rate of Tax Amount in INR
Premium `22800
SGST 9 2052
CGST 9 2052
IGST 0 0

IN WITNESS WHEREOF,the undersigned being duly authorized has hereunto set his/her hand

at ______________ this _______________ day of _______________ 20

Date of Issue: 10/11/2018

Authorized Signatory For and on behalf of
The New India Assurance Company
Limited

Policy No. : 14060034189500007006Document generated by 20050 at 10/11/2018 17:04:12 Hours.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.

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THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

Insurer Office Code : GHATKOPAR D.O. (140600)

Address : GHATKOPAR D.O. 3RD FLOOR, JYOTI
CHAMBERS, J V ROAD, KHOT LANE, GHATKOPAR
(W)

,400086
Telephone : 25102695 / 25165894
Fax : 25102774

New India Mediclaim

PREMIUM CERTIFICATE FOR THE PURPOSE OF DEDUCTION UNDER SECTION 80 D OF INCOME TAX ( AMENDMENT ) ACT 1986

This is to certify that Mr./Mrs. MRS ANURADHA A GADRE has paid ` RUPEES TWENTY-SIX THOUSAND NINE HUNDRED FOUR
ONLY (in words) towards premium for New India Mediclaim for the period 11/11/2018 12:00:01 AM to 10/11/2019 11:59:59 PM

Policy no. : 14060034189500007006

Receipt no. & date : 14060081180000036664
10/11/2018

Date of Issue: 10/11/2018

Authorized Signatory For and on behalf of
The New India Assurance Company
Limited
(Note: This certificate must be surrendered to the Insurance Company for issuance of fresh certificate in case of cancellation
of the policy or any alteration in the Insurance affecting the premium)

Policy No. : 14060034189500007006Document generated by 20050 at 10/11/2018 17:04:12 Hours.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.

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 THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

IMPORTANT

This policy is subject to the terms and conditions contained in the policy document (Clauses).

This policy is governed by Health Insurance Regulations 2016 issued by Insurance Regulatory
Development Authority of India on 12.07.2016.

This policy is also governed by IRDAI (Protection of Policyholders' Interest) Regulations, 2017.

This Schedule comes attached with the policy document (Clauses). If not attached, please ask for the
same.

Health Insurance Regulations 2016 and IRDAI (Protection of Policyholders' Interest) Regulations, 2017 are
available on the website of IRDAI.

Tax Invoice No : 14060018E0004214

IRDA Registration Number: 190

Policy No. : 14060034189500007006Document generated by 20050 at 10/11/2018 17:04:12 Hours.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.

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