Claim Approval Letter Date: 20-DEC-2021

To,
Ahmad Lone Sarir
OPPOSITE TO MEENAKSHI TECH PARK, POR-
TION OF BASEMENT AND GROUND FLOOR TO
9TH FLOOR, SURVEY,, PO Area -
GACHIBOWLI, HYDERABAD, TELANGANA,
500032,
Insured Details
Policy Number OG-22-1919-8403-00000102
Claim Number OC-22-1002-8403-00197344
Claim ID 4959606
Policy Period From: 01-SEP-21 To: 31-AUG-22
Name Of The Company DELOITTE CONSULTING INDIA PRIVATE LIMITED
Joining Date 24-MAY-2021
Name Of The Employee/ Insured AHMAD LONE SARIR
ID Card No DTT-22-624825A
Employee No 624825
Name Of The Patient SHAHEEZA BANO
Age 37
Relation SPOUSE
Hospital Name JAMMU & KASHMIR GOVERNMENT SKIMS MEDICAL COLLEGE- Srinagar
Period Of Hospitalisation DOA: 16-NOV-2021 DOD: 18-NOV-2021
Final Diagnosis Single delivery by caesarean section
Claimed Amount Details
Note: **** Field are to be considered as a deduction and should not be added in the Bill Amount.
Particular Bill Amount Disallowed Approved Amount Disallowance Reason
Amount
Non-Network co-Pay*** 0 0 ---
Room Charges 4500 0 4500
Doctor Charges 2450 0 2450
Surgeon Charges 13300 0 13300
OT Charges 3500 0 3500
Pharmacy Charges 4097 1581 2516 betadine, feeding tube, gown, sheet, yankaler, gause,
under pad, sponge, meril kit
Pre Hospitalisation 1200 0 1200
Miscellaneous 1300 1300 0 Heating 1300/-
Neo Natal Charges 750 0 750
Other Deduction*** 0 0 ---
Payment Details
Claimed Amount 31097

Total Approved Amount 28216

Disallowed Amount 2881

Beneficiary Name Ahmad Lone Sarir

* Said approved amount will be remitted in the account within 2-3 working days

Health Administration Team - Bajaj Allianz General Insurance Company Limited.

2nd Floor, Bajaj Finserv Building, Survey No: 208/1B, Behind Weik Field IT Park, Viman Nagar, Pune. Maharashtra-411014
Toll Free: 1800-103-2529 Phone: (020) 30305858 Fax: (020) 30512224/6/7
Email: hat@bajajallianz.co.in Website: www.bajajallianz.com
Regd. & Head Office: GE Plaza, Airport Road, Yerawada, Pune 411006. Toll Free: 1800-209-5858 Email: bagichelp@bajajallianz.co.in
CIN No.: U66010PN2000PLC015329 UIN No.: IRDA/NL-HLT/BAGI/P-H/V.I/47/13-14
In case of any query, kindly contact us at hat@bajajallianz.co.in or 020-30305858
If you are still not satisfied with the claim decision of the Insurance Company, you may approach the Insurance Ombudsman, established by the
Central Government for redressal of grievance. The Insurance Ombudsman is empowered to adjudicate on personal line insurance claims up to
Rs.20 lacs. Detailed process along with list of Ombudsman offices are available at http://www.policyholder.gov.in/Ombudsman.aspx
With warm regards,

Authorised Signatory
For Bajaj Allianz General Insurance Co. Ltd
Health Administration Team

Health Administration Team - Bajaj Allianz General Insurance Company Limited.

2nd Floor, Bajaj Finserv Building, Survey No: 208/1B, Behind Weik Field IT Park, Viman Nagar, Pune. Maharashtra-411014
Toll Free: 1800-103-2529 Phone: (020) 30305858 Fax: (020) 30512224/6/7
Email: hat@bajajallianz.co.in Website: www.bajajallianz.com
Regd. & Head Office: GE Plaza, Airport Road, Yerawada, Pune 411006. Toll Free: 1800-209-5858 Email: bagichelp@bajajallianz.co.in
CIN No.: U66010PN2000PLC015329 UIN No.: IRDA/NL-HLT/BAGI/P-H/V.I/47/13-14
 Health Administration Team - Bajaj Allianz General Insurance Company Limited.
2nd Floor, Bajaj Finserv Building, Survey No: 208/1B, Behind Weik Field IT Park, Viman Nagar, Pune. Maharashtra-411014
Toll Free: 1800-103-2529 Phone: (020) 30305858 Fax: (020) 30512224/6/7
Email: hat@bajajallianz.co.in Website: www.bajajallianz.com
Regd. & Head Office: GE Plaza, Airport Road, Yerawada, Pune 411006. Toll Free: 1800-209-5858 Email: bagichelp@bajajallianz.co.in
CIN No.: U66010PN2000PLC015329 UIN No.: IRDA/NL-HLT/BAGI/P-H/V.I/47/13-14
 Health Administration Team - Bajaj Allianz General Insurance Company Limited.
2nd Floor, Bajaj Finserv Building, Survey No: 208/1B, Behind Weik Field IT Park, Viman Nagar, Pune. Maharashtra-411014
Toll Free: 1800-103-2529 Phone: (020) 30305858 Fax: (020) 30512224/6/7
Email: hat@bajajallianz.co.in Website: www.bajajallianz.com
Regd. & Head Office: GE Plaza, Airport Road, Yerawada, Pune 411006. Toll Free: 1800-209-5858 Email: bagichelp@bajajallianz.co.in
CIN No.: U66010PN2000PLC015329 UIN No.: IRDA/NL-HLT/BAGI/P-H/V.I/47/13-14
 Health Administration Team - Bajaj Allianz General Insurance Company Limited.
2nd Floor, Bajaj Finserv Building, Survey No: 208/1B, Behind Weik Field IT Park, Viman Nagar, Pune. Maharashtra-411014
Toll Free: 1800-103-2529 Phone: (020) 30305858 Fax: (020) 30512224/6/7
Email: hat@bajajallianz.co.in Website: www.bajajallianz.com
Regd. & Head Office: GE Plaza, Airport Road, Yerawada, Pune 411006. Toll Free: 1800-209-5858 Email: bagichelp@bajajallianz.co.in
CIN No.: U66010PN2000PLC015329 UIN No.: IRDA/NL-HLT/BAGI/P-H/V.I/47/13-14
With warm regards,

Authorised Signatory
For Bajaj Allianz General Insurance Co. Ltd
Health Administration Team

Health Administration Team - Bajaj Allianz General Insurance Company Limited.

2nd Floor, Bajaj Finserv Building, Survey No: 208/1B, Behind Weik Field IT Park, Viman Nagar, Pune. Maharashtra-411014
Toll Free: 1800-103-2529 Phone: (020) 30305858 Fax: (020) 30512224/6/7
Email: hat@bajajallianz.co.in Website: www.bajajallianz.com
Regd. & Head Office: GE Plaza, Airport Road, Yerawada, Pune 411006. Toll Free: 1800-209-5858 Email: bagichelp@bajajallianz.co.in
CIN No.: U66010PN2000PLC015329 UIN No.: IRDA/NL-HLT/BAGI/P-H/V.I/47/13-14