HDFC ERGO General Insurance Company Limited

Certificate of Insurance 2855205098490500000

Sarv Suraksha Plus (Group)

2855205098490500000

MR RAVI RAVI
SKETCH CAD PVT
LTD SOWKATHALI STREET GANDHI
RAMANATHAPURAM, TAMIL NADU, 623707
Contact No. 8220693013

Date :07/12/2022

Dear MR RAVI RAVI

Thank you for choosing HDFC ERGO as your preferred insurance partner.We welcome you to be a part of our family!

Your coverage of insurance under the Sarv Suraksha Plus (Group) policy reference no 2855205098490500000 i s confirmed on the basis of the information and declaration
provided by you.

The details of coverage are mentioned in the enclosed certificate of insurance.

We value your relationship with us and assure you our best services at all times and we look forward to serve you.
This certificate of insurance can be renewed subject to outstanding loan tenure and loan amount at the expiry of the certificate, Please contact HDFC ERGO General Insurance
company limited for renewal.
For HDFC ERGO General Insurance Company Ltd.

Authorized Signature

HDFC ERGO General Insurance Company Limited

Tax Certificate
Dear MR RAVI RAVI,

Subject : Certificate for the purpose of deduction under section 80 D of Income Tax (Amendment) Act, 1986

This i s to certify that we have received an amount of ` 208 towards premium for Sarv Suraksha Plus (Group), Certificate No. 2855205098490500000 issued to MR
RAVI RAVI for the period 06/12/2022 to 05/12/2023.

Note : This is subject to the provisions of Section 80D of income tax (Amendment) Act, 1986 as amended from time to time.
This certificate must be surrendered to the company in case of cancellation of this policy. In event of incorrect representation of this declaration the liability shall be
upon the policy holder.

For HDFC ERGO General Insurance Company Ltd.

Date : 07/12/2022
Policy issuance office : Mumbai

Duly Constituted Attorney

HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN : HDFHLGP21002V022122. Customer Service Address: D 301, 3rd Floor,
CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078.
165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service No : +91 22-62346234/+91-120 6234 6234 | www.hdfcergo.com
 HDFC ERGO General Insurance Company Limited
Certificate of Insurance 2855205098490500000

Sarv Suraksha Plus (Group)

2855205098490500000

Certificate No. :2855 2050 9849 0500 000 Issuance Date : 07/12/2022
Period of Insurance : From 06/12/2022 12:08 hrs To 05/12/2023 Midnight
Invoice No. :205098490500000 Premium Frequency :Single
Proposer Name :Mr Ravi Ravi
MR RAVI RAVI HSN Code :997133 eIA :Not provided
SKETCH CAD PVT Customer Id :100651446680 Loan Sanction Amount :100884
LTD SOWKATHALI STREET GANDHI Master Policy No. :2999204281584601001
RAMANATHAPURAM, TAMIL NADU, 623707
Contact No. 8220693013 Master Policy Holder :HDFC BANK LTD
Name
Loan Account No. :455848270
Lending Institution :HDFC BANK LTD
Email ID :ravipmk001@gmail.com
Payment Details : SL_TW_886_061222 , Date: 06/12/2022, Bank Name:HDFC Bank Ltd
Insured Person Details
Name of Relation with 1st Policy
Group member ID Gender DOB Sum Insured
Insured Person policy holder* Inception
RAVI RAVI 2022210022761874 Applicant Male 16/05/1994 06/12/2022 100884
*Relationship is relation of Insured with policyholder
Nominee Details
Nominee Name Nominee Relationship
MEENAL Mother
Schedule of Coverage
Co-payment /
Insured Name Coverages Sub Coverages Base Sum Insured Sum Insured Deductible/
Excess
Accidental Hospitalization Expenses
Accidental Hospitalization Expenses 50000 50000 0
(India)
2250/Day for 7
Hospital Cash Hospital Cash - Accident Only 2250/Day for 7 Days 0
Days
Loss of Income - PTD 25000 25000 0
Loss of Income/EMI Protector
Termination from Employment 25000 25000 0
Major Medical Illness Essential CI Plus 25000 25000 0
RAVI RAVI Accident Death 250000 250000 0
Comatose 62500 62500 0
Personal Accident
Disappearance 250000 250000 0
Permanent Disablement (Table E) 250000 250000 0
Burglary 100000 100000 0
Earthquake 100000 100000 0
Property Coverage
Fire & Allied Perils (Contents) 100000 100000 0
Terrorism 100000 100000 0
Waiting Period Applicable
Sec Coverages Waiting Period
1 Major Medical Illness
a PED Waiting Period 48 months
b Major illness waiting period 90 days
1.I.ii Angioplasty 180 days
4.I Termination from Employment
a General Waiting Period 90 days
Survival Period Applicable
S.No. Coverage Survival Period
1 Major Medical Illness 7 Days

Premium Details (`)

Particulars RAVI RAVI
Base Premium (A) 423.93
Optional Cover Premium (B) 0
Medical Underwriting Loading (C) 0
Total Premium (D=A+B+C) 423.93
Discounts (E) 0
Goods & Service Tax (GST) (F) 76
Gross Premium (G) 424
Grand Total - Premium excluding GST (H) 424
Grand Total - Premium including GST (I) 500

For Claim/Policy related queries call us at +91- 22 6234 6234/+91- 120 6234 6234 or Visit Help Section on www.hdfcergo.com for policy copy/tax certificate/make changes/register &
track claim.
If the premium is not realised the policy shall be void from inception.Consolidated stamp duty for this Insurance Policy is paid by Demand Draft, vide Receipt/Challan noNO.LOA/CSD/477/2022/4252 dated
29/09/2022 as prescribed in Government of Maharashtra Order No. Mudrank-2017/CR.97/M-1, dated the 09th January 2018. Goods & Services Tax Registration No: 33AABCL5045N1ZFGST for this invoice is not
payable under reverse charge basis. I/ We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the aggregate turnover notified under sub-rule (4) of
rule 48, we are not required to prepare an invoice in terms of the provisions of the said sub-rule
Branch :248b, b-1, c, c-1, rekha towers, kamarajar salai rd, madurai

HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN : HDFHLGP21002V022122. Customer Service Address: D 301, 3rd Floor,
CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078.
165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service No : +91 22-62346234/+91-120 6234 6234 | www.hdfcergo.com
 HDFC ERGO General Insurance Company Limited

2855205098490500000

For HDFC ERGO General Insurance Company Ltd.

Agent Name : HDFC BANK LTD
Agent Code : 201587086428 Tel No. : 91-22-61606161

Duly Constituted Attorney

For detailed policy terms and conditions please visit our website https://www.hdfcergo.com/download/policy-wordings

HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN : HDFHLGP21002V022122. Customer Service Address: D 301, 3rd Floor,
CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078.
165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service No : +91 22-62346234/+91-120 6234 6234 | www.hdfcergo.com
 HDFC ERGO General Insurance Company Limited

2855205098490500000

HDFC ERGO General Insurance Company Limited 0

Policy No.:POLICY_NO This card is for identification purpose only.
Valid From: NaD Renewal Date: NaD
Card has to be presented to the Network Service Provider at the time of admission/ availing
Insured Name Date Of Birth Gender cashless hospitalization o r any other services. Insurance claim will be processed in accordance
with the policy term & conditions. Card does not guarantee cashless hospitalization or any other
service. For more details and updated list of Network Service Provider please refer our website or
RAVI RAVI 16/05/1994 Male call our call centre. This card is valid till the time policy is active.

Customer Service No : 022 - 6234 6234 / 0120 - 6234 6234

: fax
Email : healthclaims@hdfcergo.com
Processing Centre : Address
Website : Website

HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN : HDFHLGP21002V022122. Customer Service Address: D 301, 3rd Floor,
CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078.
165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service No : +91 22-62346234/+91-120 6234 6234 | www.hdfcergo.com