Date : 13 June 2022

Mr Sukhadeo Sitaram Vibhute

3-G, Nihal Apartment, Kabad Ali, Tembhi Naka
Thane (W) 400601

Policy No. : 18576892

Mobile No. : 7021780229

Subject : Renewal of Policy No. 18576892

Dear Mr Sukhadeo Sitaram Vibhute,

We take this opportunity to thank you once again for entrusting us with your health; and assure you of our commitment to keep you worry-
free….hamesha.

We are pleased to confirm renewal of your policy; and enclosed are the following documents with regards to the same:

Policy Certificate
Premium Acknowledgement (including tax certificate)
To enjoy seamless services offered by your policy, please note the following:

- Renewal of this policy does not change or alter the Policy Terms and Conditions of “Care”.

- Health Cards and all other documents issued along with your first policy shall continue to be valid.

- To enable quicker processing, we request you to mention your Member Card Number / Policy Number in all future correspondence with us.

For any clarifications, please feel free to mail us at customerfirst@religarehealthinsurance.com or call us at 1800-200-4488.

Team Religare Health Insurance

Policy Certificate

Mr Sukhadeo Sitaram Vibhute Policy No. 18576892

Plan Name Care
3-G, Nihal Apartment, Kabad Ali, Tembhi Cover type Individual
Naka Policy Period - Start Date 00:00 hrs 13-June-2022
Thane (W) 400601
Policy Period - End Date Midnight 12-June-2023
Premium Paid Rs. 25016
(Premium 21,200 + 18% GST 3816)
Premium Payment Mode Single Premium

Policyholder Date of Birth Client ID

Sukhadeo Sitaram Vibhute 01-Aug-1953 61500048

Details of Insured
Insured with the *No Claim *No Claim
Name Client ID Date of Birth Relationship Company Pre-existing diseases
Bonus Bonus-SUPER
(since)
Sukhadeo Vibhute 61500050 01-Aug-1953 FATHER 13-June-2022 NONE 50,000.00 250,000.00
Jayshree Vibhute 61500051 01-July-1968 MOTHER 13-June-2023 NONE 50,000.00 250,000.00
*The No Claim Bonus & No Claim Bonus-SUPER shown in the Policy Certificate is provisional. The No Claim Bonus & No Claim Bonus-SUPER calculated on the Expiry Date, shall only be considered as
final. However, in case of any change in provisional No Claim Bonus & No Claim Bonus-SUPER , the same shall be intimated to the Policyholder by the Company through a separate endorsement.

Details of Cover

S No. Particulars Details

1 Sum Insured Rs. 7,00,0000
2 No Claim Bonus - SUPER (Add-on Benefit) Applicable
Benefits

S No. Particulars Basis of Offering (On Annual Basis)

1 Hospitalization Expenses (Conditions for Medical Expenses) Upto Rs.7,00,000 (i. Room Category = Single Private Room)

2 Pre-hospitalisation & Post-hospitalization Expenses Pre-hospitalization upto 30 days; Post-hospitalization upto 60 days

3 Ambulance Cover Upto Rs. 2,000 per Claim

4 Organ Donor Cover Upto Rs. 1,00,000 per Policy Year

5 Domiciliary Hospitalization Upto 10% of Sum Insured per Policy Year

6 Health Check-up 1 Check-up per adult, per Policy Year

7 Recharge of Sum Insured 1 re-instatement upto Sum Insured per Policy Year

8 Second Opinion 1 Opinion per Policy Year per Insured Person for each Major Illness
10% of Sum Insured for each Claim free year, maximum upto 50% of
9 No Claims Bonus
Sum Insured; reduced by 10% of Sum Insured in case of Claim

50% of Sum Insured for each Claim free year, maximum upto 100% of
10 No Claim Bonus - SUPER (Add-on Benefit)
Sum Insured; reduced by 50% of Sum Insured in case of Claim

For Religare Health Insurance Company Limited

Authorized Signatory Date of Issue : 23-June-2022 Place of Issue : Saket, New Delhi

Branch Details : RHICL, Saket, Delhi, Delhi - 110017 Branch Contact No. : 1800-200-4488
Correspondence Address:
Religare Health Insurance Company Limited
GYS Global, Plot No. A3, A4, A5,Sector-125,Noida,UP-201301 Contact No : 1800-200-4488 Fax:1800-200-6677
Website : www.religarehealthinsurance.com Email : customerfirst@religarehealthinsurance.com
Consolidated Stamp Duty paid vide F.No.10 (17685)/COS(HQ)/CD dated 10th Jan 2015
Service Tax Registration No:AADCR628INSD001 IRDA Registration Number - 148 UIN: IRDA/NL-HLT/RHI/P-H/V.I/253/13-14
Registered office address : D-3, P3B, District Centre, Saket, New Delhi – 110 017
CIN : U66000DL2007PLC161503
Note:

Attached with this Policy Certificate are the Policy Terms and Conditions and Annexures. Please ensure that these documents h ave been received, read and understood. If any of these documents
have not been received, please email at customerfirst@religarehealthinsurance.com or write to the Company. This Policy Certificate in original must be surrendered to the Company in case of
cancellation of the Policy.
 Sukhadeo Vibhute

61500050

01-Aug-1953

Jayshree Vibhute

61500051

01-July-1968
 Premium Acknowledgement

Policy No. 18576892

Client ID 61500048
Policyholder Mr. Sukhadeo Sitaram Vibhute
Address 3-G, Nihal Apartment, Kabad Ali, Tembhi Naka
Thane (W) 400601

Policy Period 13-June-2022 to 12-June-2023

Premium Details
Particulars Amount (in Rs.)

Gross Premium
Care 44,490.11
-NCB Super 2,579.01

Service Tax & Levies 5,054.22

Total 52,124.00

The Premium is rounded off to the nearest rupee.

Eligibility of Premium for Deduction u/s 80D of the Income Tax Act, 1961
This is to certify that Religare Health Insurance Co.Ltd. has received an amount of Rs. 52,124.00/- from Mr Sukhadeo Sitaram Vibhute towards
Payment of Health insurance premium as per the details mentioned above. The premium paid for this policy is eligible for applicable tax benefits u/s
80D of the Income Tax Act, 1961 and amendments thereof.

For Religare Health Insurance Company Limited

Authorized Signatory Date of Issue: 23-June-2022 Place of Issue: Saket, New Delhi

IRDA Registration Number - 148

Registered office address : D-3, P3B, District Centre, Saket, New Delhi – 110 017
CIN : U66000DL2007PLC161503

Note
1) In case of any discrepancy, the Policyholder is requested to contact the Company immediately.
2) Any amount paid in cash towards the premium would not qualify for tax benefits as mentioned above.
3) 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.

Religare Health Insurance Company Limited

Correspondence address : GYS Global, Plot No. A3, A4, A5, Sector - 125, Noida, U.P.-201301
Website : www.religarehealthinsurance.com E-mail : customerfirst@religarehealthinsurance.com UIN: IRDA/NL-HLT/RHI/P-H/V.I/253/13-14 Call Us : 1800-200-4488