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Date : 22 January 2021

Ms Divla Saiyyan

Forest Range Office Bajag

Village Midli Bajag

Dindori

Dindori 481882

Madhya Pradesh

Policy No. : 19743516

Mobile No. : 9617729183

Dear Ms Divla Saiyyan,

Welcome to a world where what matters, above all, is your Health....Hamesha!

Welcome to Care Health Insurance.

At Care, it's our mission to provide you access to the highest quality of healthcare and put you back on the road to a worry-free recovery, without a
care about medical bills and other related expenses. Moreover, as a member of a group that is driven by innovation and constantly aims at creating
value, you can expect an unmatched bouquet of products and services.

Thank you for choosing POS Secure - A Personal Accident Cover that directly addresses every concern which can arise as a result of a serious
accident. To help you understand our benefits & services better, please go through the 'Know your policy better' kit that accompanies this letter and
constitutes the following details:

Policy Certificate
Premium Acknowledgement
Key Policy Information
Policy Terms and Conditions
Claim Process

What’s more ! Our policy comes with a free-look period of 15 days from the date of receipt. Hence, after purchasing the policy, if you find it
unsuitable, you can cancel and return the policy to us.

To further simplify procedures, we're online at www.careinsurance.com; where you can view network hospitals across the country, cashless
procedures and do much more.

For any assistance feel free to mail us at customerfirst@careinsurance.com or call 1800-102-4488.

Once again, we thank you for this opportunity to serve you, and wish you and your loved ones good health always!

Team Care Health Insurance

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Divla

Policy Certificate

Policy No. 19743516

Ms Divla Saiyyan Plan Name
Cover type
Forest Range Office Bajag Policy Period - Start Date
Policy Period - End Date
Village Midli Bajag Nominee Name (Relation)
Premium Paid
Dindori
Dindori 481882
Premium Payment Mode
Madhya Pradesh 23
POS SECURE 1
Individual
00:00 hrs 23-Jan-2021
Midnight 22-Jan-2022
Sunil Saiyyan (Husband)
Rs. 2482
(Premium Rs 2103 + CGST Rs 189.27 + IGST
Rs 0 + SGST Rs 189.27 + UGST Rs 0 + Kerala
Flood Cess Rs 10729.25)
Single Premium

Policyholder Date of Birth Client ID

Divla Saiyyan 01-Jul-1983 83526411

Details of Insured

Name Client ID Date of Birth Relationship Insured with the Company (since)

Divla Saiyyan 83526411 01-Jul-1983 Member 23-Jan-2021

1 Details of Cover
S No. Particulars Details
1 Sum Insured Rs. 10,00,000

POS Details
Name Code PAN/Aadhar No. Contact Number
Shreyansh Pol 20332637 7777880211

for Claims & Assistance: Call 1800-102-4488

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Benefits
S No. Particulars Basis of Offering (On Annual Basis)
1 Accidental Death 100% of Sum Insured

2 Permanent Total Disablement As per clause 2.2

3 Permanent Partial Disablement as per clause 2.3

4 Fracture Up to 50,000

Coverage amount of last Policy Year will be enhanced by flat 5% of

5 Loyalty Benefit SI,on a cumulative basis. Max. Increase up to 50% of SI

6 Accidental Hospitalization Up to 50,000

7 Temporary Total Disablement Up to Rs 5000 per week, Maximum up to 100 weeks

For Care Health Insurance Limited (Formerly known as Religare Health Insurance Company Limited)

Authorized Signatory Date of Issue : 22-Jan-2021 Place of Issue : Gurgaon, Haryana

Service Branch : CHIL, 1193, Weight Town Behind Icici Bank, Chanchal Bai College Road Bhawani Prasad Tiwari Ward, Wright Town, Golbazar, Jabalpur, Madhya Pradesh - 482001 Branch Contact
No. : 1800-102-4488
Correspondence Address: 22-Jan
Care Health Insurance Limited (Formerly known as Religare Health Insurance Company Limited)
Unit no 604 - 607, 6th Floor, Tower C, Unitech Cyber Park, Sector 39, Gurgaon -122001.(HARYANA) Contact No : 1800-102-4488
Website : www.careinsurance.com Email : customerfirst@careinsurance.com
Consolidated Stamp Duty paid vide E-Challan GRN no. 69910718 dated 02 Dec 2020, RCM Applicability- N/A
SAC: 997133 and Description of Service: Accident and Health Insurance Services State GSTIN No.: 23AADCR6281N1Z0 IRDA Registration Number - 148 UIN: RHIPAIP18048V021718
Registered office address : 5th Floor, 19 Chawla House, Nehru Place, New Delhi - 110019
CIN : U66000DL2007PLC161503

Note:
Attached with this Policy Certificate are the Policy Terms & Conditions, Add-on Benefits (if opted) and Annexures. Please ensure that these documents have been received, read and understood. If any of
these documents have not been received, please email <customerfirst@careinsurance.com> or contact the Company at <1800-102-4488>. This Policy Certificate in original must be surrendered to the
Company in case of cancellation of the Policy. Summary of matters that are stated in the Policy terms and conditions to comply Regulation 7 of Protection of Policyholders' Interests, 2002 and a copy
of the Key Policy Information are also enclosed herewith.
0 NB

Premium Acknowledgement

Policy No. 19743516

Client ID 83526411
Policyholder Ms Divla Saiyyan
Address Forest Range Office Bajag
Village Midli Bajag
Dindori
Dindori 481882, Madhya Pradesh
Policy Period 23-Jan-2021 to 22-Jan-2022

Premium Details
Particulars Amount (in Rs.) 1,6

Gross Premium
POS Secure 1 1,630.00
-Accidental Hospitalization 440.00
-Temporary Total Disablement 33.00
V

Goods & Services Tax (GST) 378.54

Total 2,482.00

The Premium is rounded off to the nearest rupee.

For Care Health Insurance Limited (Formerly known as Religare Health Insurance Company Limited)

Authorized Signatory Date of Issue: 22-Jan-2021 Place of Issue: Gurgaon, Haryana

This Ms fro 210 towa
Registered office address : 5th Floor, 19 Chawla House, Nehru Place, New Delhi - 110019
CIN : U66000DL2007PLC161503

Note
1) In case of any discrepancy, the Policyholder is requested to contact the Company immediately.
2) This document must be surrendered to the Company in case of Cancellation of the Policy or for the issuance of a fresh certificate in the case of any alteration in the Policy.
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Proposal Form-'POS Secure 1'

Dear Ms Divla Saiyyan

In reference to your online proposal (3120017487054) for POS Secure 1- Personal Accident policy, please find below the details as provided by you:

Proposer Details

Name : Ms Divla Saiyyan

Address : Forest Range Office Bajag

Village Midli Bajag
Dindori
Dindori-481882
Madhya Pradesh

Date of Birth : 01/07/83

Landline :

Mobile : 9617729183

E-mail : SUNILSAIYYAN25@GMAIL.COM

Details of the Persons be Insured

Date of Pre-existing
Name Relation Annual Income Occupation Occupation Class
Birth Diseases
DIVLA SAIYYAN 01/07/83 MEMBER NONE 500,000.00 Salaried C1

Additional Details
A. Does your job require you to engage in significant manual labor or hazardous activities or requires handling hazardous material or working at
significant heights or with high voltage

Insured 1
No
B. Have you ever been diagnosed or are under treatment for any terminal illness or any illness/disease restricting your activities (e.g. Epilepsy/Seizure
disorder)
Insured 1
No

C. Any existing Disability/Deformity (physical or mental impairment/infirmity or any condition hampering vision, hearing or mobility)

Insured 1
No
D. Has any company ever declined to issue/renew a Personal Accident policy for any proposed? If yes, please provide details

Insured 1
No
Occupations Code Descriptions *
Occupation Code C1: Employees without exposure to manual work outside Office (Admin/Finance and Accounting /Sales & Marketing / BPO/IT /Actuaries
/Audit/Operations/HR/R&D)
Occupation Code C2: Professionals without exposure to manual work outisde office(Academicians/Healthcare/Legal/Consultants/Architects/Engineer/Real-Estate)
Occupation Code C3: Technicians/Mechanics(Except Heavy machinery Operators/Electrician/Nuclear and chemical Lab Technician)
Occupation Code C4: Business owners (Excluding Chemical, Arms and Ammunitions,Explosives, Fireworks)
Occupation Code C5: As mentioned
 You agreed to following terms & conditions of the purchase of policy
a. I have read and understood the brochure/prospectus/sales literature/Terms and Conditions of the Policy and confirm to abide by the same.
b. Receipt of proposal form by the Company shall not be construed as acceptance of proposal. Commencement of risk under the Policy shall be subject to realization of full
premium and individual underwriting by the Company. The Company at its sole discretion reserves the right to accept or reject or load any proposal. Policy would start
from the date as specified in the Policy Certificate.

c. I understand that the Policy Period Start Date as specified in the Policy Certificate shall be from the 00:00 hours of the next day of the Proposal receipt at branch,
proposed policy period start date as opted by me or cheque date, whichever is later.

d. I understand that the Policy shall become void at the Company's option, in the event of any untrue or incorrect statement, misrepresentation, non-description or
non-disclosure of any material fact, in the proposal form/personal statement, declaration and connected documents or any material information having been withheld by
me or anyone acting on my behalf.

e. I consent to and authorize the Company and/or any of its authorized representative agents to seek medical information from any hospital/medical practitioner or any other
related entity that I have attended or may attend in future concerning any illness or injury.
f. I consent to provide a valid age proof and identity proof at the time of claims or any other time when required by the Company. h.I authorize the Company to exchange,
share or part with the information relating to myself/person(s) to be insured with any external entity other than regulatory and statutory bodies, as may be required and I
will not hold the Company or its agents liable for use/sharing of this information.

g. I authorize the Company to exchange, share or part with the information relating to myself/person(s) to be insured with any external entity other than regulatory and
statutory bodies, as may be required and I will not hold the Company or its agents liable for use/sharing of this information.
h. I/We agree and undertake to convey to the Company any change/alterations carried out in the risk proposed for insurance after submission of this proposal form.
i. I/We consent to receive information from the Company the through physical, electronic or telecommunication means from time to time.

the undersigned hereby declare on my behalf and on behalf of each of the persons proposed to be insured that the above statements and particulars are true, accurate and
complete and correct in all respects and that there is all information which is relevant to this proposal that has been disclosed and not withheld from the Company. I declare
that the money used to make the premium payment has not been derived from any illegal activity or unaccounted funds. I further declare and agree that this declaration and
the answers given above shall be held to be promissory and shall be the basis of the contract between me/us and the Company.

You also agreed to receive service SMS and E-mail alerts.

Signature Not
Verified
Digitally signed by
MANISH DODEJA
Date: 2021.02.13
07:13:43 IST
Reason: I'm the author
Location: India