Scribd Logo
Upload

Welcome to Scribd!

  • Consolidated Policy Schedule

    Uploaded by

    Neem Lal
    35 views4 pages
    The document is an insurance policy certificate that: 1) Provides policy details for Mr. Neem Lal such as the policy number, period of coverage, insured amount, and policy tenure. 2) Lists the insured person, Ms. Aarti Rani, with their name, date of birth, age, gender, relationship and sum insured. 3) Notes that the proposer should review the details and contact the company within 15 days if any discrepancies are found, otherwise the policy will be considered accurate.

    Original Description:

    Original Title

    Consolidated Policy Schedule (1)

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    The document is an insurance policy certificate that: 1) Provides policy details for Mr. Neem Lal such as the policy number, period of coverage, insured amount, and policy tenure. 2) Lists the insured person, Ms. Aarti Rani, with their name, date of birth, age, gender, relationship and sum insured. 3) Notes that the proposer should review the details and contact the company within 15 days if any discrepancies are found, otherwise the policy will be considered accurate.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    35 views4 pages

    Consolidated Policy Schedule

    Uploaded by

    Neem Lal
    The document is an insurance policy certificate that: 1) Provides policy details for Mr. Neem Lal such as the policy number, period of coverage, insured amount, and policy tenure. 2) Lists the insured person, Ms. Aarti Rani, with their name, date of birth, age, gender, relationship and sum insured. 3) Notes that the proposer should review the details and contact the company within 15 days if any discrepancies are found, otherwise the policy will be considered accurate.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    of 4

    Risk Assumption Letter

    Dear Sir / Madam,


    1
    We thank you for placing your confidence with ICICI Lombard for your Health Insurance Needs.
    1
    Please find attached herewith Policy No. 4128i/HPPN/178474374/01/000 which has been issued based on the details furnished by the applicant.
    2
    Name of Proposer NEEM LAL Policy Tenure (in Years) 1
    H NO 14, NEAR RAILWAY LINE, GANESH NAGAR TEH
    RAJPURA DISTT PATIALA, RAJPURA, PUN-140401, 0,
    H NO 14 , NEAR RAILWAY LINE, GANESH NAGAR TEH From 00:00 hrs 25-Aug-2020 To 23:59 hrs
    Address Period of Insurance
    RAJPURA DISTT 24-Aug-2021
    PATIALA,-,-,-,-,RAJPURA,PUN-140401 - - -, PATIALA,
    PUNJAB - 140401
    Policy Issued On 11-Aug-2020 Email Address NEEMLALBANN@YAHOO.COM
    GSTIN (Customer) Mobile No. 8283817187

    Insured Details
    2
    Name of the Date of Age Gender Relationship with Annual Sum Pre-existing Sub-limit Voluntary Optional add
    insured (s) Birth Y M policy holder Insured illness / injury Deductible on cover
    AARTI RANI 03-Apr-1997 23 4 Female SPOUSE 500000 None None 0 None

    Please go through the details as furnished in the format and the policy document and confirm that same are order. In case there is any discrepancies / variations,
    you are requested to write back to us immediately at customersupport@icicilombard.com or contact at 24 hour helpline number 1800 2666 for necessary changes
    / rectifications.

    In the absence of any communication from you in this connection within a period of 15 days of receipt of this letter, we would take it that the issued policy is in
    order as per your proposal.

    Signature Not Verified


    Digitally signed by DS ICICI
    LOMBARD GENERAL
    INSURANCE COMPANY
    LIMITED
    Date: 2020.08.11 15:00:10
    IST
    109/20150914/284

    ICICI Lombard General Insurance Company Limited


    IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 ICICI Lombard Complete Health Insurance UIN - lClHLlP20084V03l920
    Mailing Address: Registered Office: Toll free no.: 1800 2666
    ICICI Lombard General Insurance ICICI Lombard House, 414 Veer Alternate No.: +918655 222 666 (chargeable)
    Company Limited, Interface Building No.: Savarkar Marg, Near Siddhi Email: customersupport@icicilombard.com
    16, 601 / 602, 6th Floor, New Link Road, Vinayak Temple, Prabhadevi, Website: www.icicilombard.com 1/4
    Malad (West), Mumbai - 400 064. Mumbai - 400 025.
    Policy Certificate
    POLICYALL
    Proposer Name NEEM LAL Policy No. 4128i/HPPN/178474374/01/000
    Address H NO 14, NEAR RAILWAY LINE, GANESH Period of Insurance From 00:00 hrs 25-Aug-2020 To 23:59 hrs
    NAGAR TEH RAJPURA DISTT PATIALA, 24-Aug-2021
    RAJPURA, PUN-140401, 0, H NO 14 , NEAR
    RAILWAY LINE, GANESH NAGAR TEH
    RAJPURA DISTT Policy Tenure 1
    PATIALA,-,-,-,-,RAJPURA,PUN-140401 - - -,
    PATIALA, PUNJAB - 140401
    Contact No. 8283817187 LAN No. NA
    Email Address NEEMLALBANN@YAHOO.COM Policy Issuing Office Prabhadevi
    Nominee Name AARTI RANI Policy Issued On 11-Aug-2020
    Relationship With SPOUSE Previous Policy No. 4128i/iHP/178474374/00/000
    Policyholder
    Appointee Name Nominee Age NA
    GSTIN Number (Customer) Servicing Branch Name New Delhi
    Servicing Branch Address Fourth Parsavnath Capital Tower Bhai Veer Invoice Number 100820178871
    Singh Marg, New Delhi New Delhi 110001

    Insured's Date of Age Date of Gender Relation With Annual Sum Pre-existing Optional Permanent
    Name(s) Birth Joining Proposer Insured (`) Illness/ Injury Add-on Cover* Exclusion
    Y M Remarks
    AARTI RANI 03-Apr-1997 23 4 25-Aug-2019 Female SPOUSE 500000 None None None
    Plan Details
    GSTIN Reg. No HSN/SAC code The stamp duty of ` 1 paid vide
    Plan Name Additional Sum Insured Sub-limit Voluntary
    deface no. CSD14202013942020
    (`) Deductible
    dated 26-May-2020
    9971 GENERAL
    HPP_Individual_Adult_1
    50000 None 0 07AAACI7904G1ZP INSURANCE
    Year_N
    SERVICES
    Premium Details (`)
    IGST
    Basic Premium Total Tax Payable Total Premium
    % `
    7105.93 18 1279.07 1279.07 8385

    2 Agent Details
    Agent ICICI BANK Agent Agent
    2470377 7082900149
    Name LIMITED Code contact No.

    SYSESB00102415318
    Important: Insurance benefit shall become voidable at the option of the company, in the event of any untrue or incorrect statement, misrepresentation
    non-description of any material particular in the proposal form/ personal statement, declaration and connected documents, or any material information has been
    withheld by beneficiary or anyone acting on beneficiary's behalf to obtain insurance benefit. Please note that any claims arising out of pre-existing illness/ injury/
    symptoms i s excluded from the scope of this policy subject to applicable terms and conditions. Refer to policy wordings for the terms and conditions. All disputes
    are subject to the jurisdiction of Mumbai High Court only. For claims, please call us at our toll free no. 1800 2666 or e-mail to us at ihealthcare@icicilombard.com or
    write to us at ICICI Lombard GIC, ICICI Bank Tower, Plot no-12, Financial district Nanakramguda, Gachibowli, Hyderabad, Andhra Pradesh 500032.

    This policy has been issued based on the details furnished by the policyholder. Please review the details furnished in the policy certificate and confirm that same
    are in order. In case of any discrepancy/ variation, you are requested to call us immediately at our toll free no. 1800 2666 or write to us at
    customersupport@icicilombard.com. In the absence of any communication from you within the period of 15 days of receipt of this document, the policy would be
    deemed to be in order and issued as per your proposal. All refunds and claim payment will be done through NEFT only. In case of addition of member/ increase in
    sum insured, fresh waiting period will be applicable to new member/ increased sum insured. This policy certificate is to be read with the policy wordings, as one
    contract or any word or expression to which a specific meaning has been attached in any part of this policy shall bear the same meaning wherever it may appear.
    109/20150914/284

    ICICI Lombard General Insurance Company Limited


    IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 ICICI Lombard Complete Health Insurance UIN - lClHLlP20084V03l920
    Mailing Address: Registered Office: Toll free no.: 1800 2666
    ICICI Lombard General Insurance ICICI Lombard House, 414 Veer Alternate No.: +918655 222 666 (chargeable)
    Company Limited, Interface Building No.: Savarkar Marg, Near Siddhi Email: customersupport@icicilombard.com
    16, 601 / 602, 6th Floor, New Link Road, Vinayak Temple, Prabhadevi, Website: www.icicilombard.com 2/4
    Malad (West), Mumbai - 400 064. Mumbai - 400 025.
    Tax Certificate
    2

    To
    NEEM LAL
    H NO 14, NEAR RAILWAY LINE, GANESH NAGAR TEH
    RAJPURA DISTT PATIALA, RAJPURA, PUN-140401, 0
    H NO 14 , NEAR RAILWAY LINE, GANESH NAGAR TEH
    RAJPURA DISTT PATIALA,-,-,-,-,RAJPURA,PUN-140401 - - -
    PATIALA
    PUNJAB - 140401
    ANNUAL
    Subject: Premium certificate for the purpose of deduction under section 80D of Income Tax
    Act, 1961 and any amendments made thereafter.

    Dear NEEM LAL,

    This is to certify that the Company has received the premium dated Aug 08, 2020 for Health
    insurance coverage under "Health Insurance Policy" with the following details.

    Policyholder's NEEM LAL Policy Number 4128i/HPPN/178474374/0


    Name 1/000
    Policy Start Date Aug 25, 2020 Policy End Date Aug 24, 2021
    Plan Name HPP_Individual_Adult_1Y Total Premium Paid 8385
    GSTIN Number GSTIN Reg.No (ICICI 07AAACI7904G1ZP
    (Customer) Lombard)
    Servicing Branch New Delhi Servicing Branch Fourth Parsavnath Capital
    Name Address Tower Bhai Veer Singh
    Marg, New Delhi New
    Delhi 110001

    Premium Details (`)


    IGST
    Basic Premium Total Tax Payable Total Premium
    % `
    7105.93 18 1279.07 1279.07 8385
    Financial Year Amount
    2020-2021 8385.00
    The product is eligible for deduction u/s 80D of the Income Tax, 1961 and any amendments
    made there to.

    Note: This certificate must be surrendered to the Insurance Company in case of Cancellation of
    the Policy. In the event of incorrect representation of this declaration, the liability shall be upon
    the policyholder.
    109/20150914/284

    ICICI Lombard General Insurance Company Limited


    IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 ICICI Lombard Complete Health Insurance UIN - lClHLlP20084V03l920
    Mailing Address: Registered Office: Toll free no.: 1800 2666
    ICICI Lombard General Insurance ICICI Lombard House, 414 Veer Alternate No.: +918655 222 666 (chargeable)
    Company Limited, Interface Building No.: Savarkar Marg, Near Siddhi Email: customersupport@icicilombard.com
    16, 601 / 602, 6th Floor, New Link Road, Vinayak Temple, Prabhadevi, Website: www.icicilombard.com 3/4
    Malad (West), Mumbai - 400 064. Mumbai - 400 025.
    Name : AARTI RANI
    Policy No. : 4128i/HPPN/178474374/01/000
    Card No. : 118505704
    Gender : Female Age : 23 Dob : 03-Apr-1997
    Valid Upto : 24-Aug-2021

    109/20150914/284

    ICICI Lombard General Insurance Company Limited


    IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 ICICI Lombard Complete Health Insurance UIN - lClHLlP20084V03l920
    Mailing Address: Registered Office: Toll free no.: 1800 2666
    ICICI Lombard General Insurance ICICI Lombard House, 414 Veer Alternate No.: +918655 222 666 (chargeable)
    Company Limited, Interface Building No.: Savarkar Marg, Near Siddhi Email: customersupport@icicilombard.com
    16, 601 / 602, 6th Floor, New Link Road, Vinayak Temple, Prabhadevi, Website: www.icicilombard.com 4/4
    Malad (West), Mumbai - 400 064. Mumbai - 400 025.

    You might also like