Date:

To, 02/04/23
The Manager,
Bajaj Allianz General Insurance Place:
Company Office: BAJAJ ALLIANZ KSA
GENERAL INSURANCE CO.
LTD.BAJAJ ALLIANZ
HOUSE,AIRPORT ROAD,
YERAWADA,PUNE - 411006

Subject: Extension of policy

Reference: Insured Name: Sheikh Abdullah Aleem
Policy Number: 12-9911-0000842941-00 / 12-9911-0002381606-00
Policy period: From: 10/Jan/2023 to 14/April/2023
Date of Birth: 20/12/1993 Age: 29

Dear Sir.

I hereby declare that I am in Good Health and that no event has occurred
which can give rise to any claim in my earlier policy period mentioned
above

I request that my policy be extended further for 47 days so that the total
duration of cover for me overseas would be 141 days from 10 Jan 2023
Upto 30 Jul 2023.

The past history of any illness / disease /ailment / treatment / consultations is

as follows: N/A
No illness in the past

I reconfirm that I am in good health and that I had given a proposal form at
the time of taking the policy and that this declaration shall be the basis for
the issuance of policy for the additional days requested above and it will be
subject to the standard terms and conditions and special clauses as applied to
my policy specifically.
With regards,

Signature and Name of insured.

Sheikh Abdullah Aleem
Insured person name