IFFCO-TOKIO GENERAL INSURANCE CO.

LTD
Regd. Office: IFFCO Sadan, C-1, Distt. Centre, Saket, New Delhi-110017

Health Protector - RENEWAL NOTICE

( UIN : IFFHLIP21323V032021 )

Insured Details Policy Issuing Office Address

DHARMISTHABEN M PANCHAL 301, 3rd Floor, The Address Building,
A 303 HIMGANGA APPT, Nr Bikes Auto Show Room,
NR A ONE SCHOOL Navrangpura,
Ahmedabad
SUBHASH CHOK
AHMEDABAD
MEMNAGAR 380009
AHMEDABAD G.P.O. H.O INDIA
AHMADABAD (M CORP.) GSTIN : 24AAACI7573H1ZI
GUJARAT Phone No :
PANCHAL,
INDIA Agent Name :
INDIRABEN H
Pin Code : 380001 Agent No : 51002004
Tie Up No : 51002575
Contact No : *******653 Agent Mobile No : NA

Subject :Renewal Notice of IHP Policy No :- H0065272 valid till 17/02/2022

Dear Valued Customer,

We thank you for choosing IFFCO-TOKIO General Insurance for your insurance needs. We wish to inform you that your Health Protector Policy is valid
till 17/02/2022 . Details of the policy under renewal are in below table.

Basic Sum Critical Illness

Name D.O.B Age Relation Rider Sum Insured Cumulative Bonus
Insured

DHARMISTHABEN
28/12/1963 58 Self 300000 300,000 45000.00
M PANCHAL

Gross Premium Discount Net Premium Total GST Payable Amount

13989.00 0.00 19025.04 3424.51 22450.00

Enhance Your Sum Insured NOW !! (Only applicable in case of No Claim in Expiring Policy)

Member Name Basic Sum Insured Critical Illness SI Cumulative Bonus Total Premium

DHARMISTHABEN M
450000 450000 45000 29835.00
PANCHAL

DHARMISTHABEN M
400000 400000 45000 27656.00
PANCHAL

DHARMISTHABEN M
350000 350000 45000 25564.00
PANCHAL

Riders Included
Room rent waiver Rider
Critical Illness Rider Yes Yes
(Applicable for sum insured less than 5 lakhs)

Discounts Applied :- No

RQ-IHP-20211116-1267 Page 1 of 2
PLEASE NOTE:

1. The said renewal notice is generated as per the claims data available in system at the time of generation of renewal notice. In case a claim has occurred earlier or
occurs in future, till the expiry of the policy, the Company reserves the right to modify cumulative bonus and policy premium. Accordingly the policy holder shall
be required to deposit differential amount.
2. To ensure continuity of your policy, kindly renew before expiry date. Please note that the renewal after 30 days of expiry of policy will result into loss of all the
benefits available for continuous renewal.
3. You are requested to remit Cheque/DD drawn in favor of "IFFCO-TOKIO General Insurance Co. Ltd." before the expiry of the policy to your agent or to the
above mentioned policy issuing branch office.
4. The contract of Insurance is based on facts declared in proposal/ change request form. You are advised to inform any changes which have occurred since policy
inception or last renewal date. Please also retain copies of record supplied to company for renewal of policy.

*The above premium is inclusive of discounts (as applicable).

Thanking you for placing your trust and confidence in IFFCO-TOKIO General Insurance Co. Ltd. and assuring you of our best attention at all times.

RQ-IHP-20211116-1267 Page 2 of 2