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    HSAA188212000100

    Uploaded by

    Taquee Ahmad
    This document is an insurance policy document from Royal Sundaram General Insurance Co. Ltd. addressed to Taquee Ahmad. It includes: 1) An insurance certificate for a family health floater policy with Rs. 300,000 sum insured for Taquee Ahmad and family members. 2) Details of insured persons, premium paid, and TPA information. 3) A note stating that 50% of pre-medical expenses will be reimbursed if the insured had undergone checks for the policy. 4) Contact information for customer service and a request to contact them if any queries arise.

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    © All Rights Reserved
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    HSAA188212000100

    Uploaded by

    Taquee Ahmad
    225 views3 pages
    This document is an insurance policy document from Royal Sundaram General Insurance Co. Ltd. addressed to Taquee Ahmad. It includes: 1) An insurance certificate for a family health floater policy with Rs. 300,000 sum insured for Taquee Ahmad and family members. 2) Details of insured persons, premium paid, and TPA information. 3) A note stating that 50% of pre-medical expenses will be reimbursed if the insured had undergone checks for the policy. 4) Contact information for customer service and a request to contact them if any queries arise.

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    This document is an insurance policy document from Royal Sundaram General Insurance Co. Ltd. addressed to Taquee Ahmad. It includes: 1) An insurance certificate for a family health floater policy with Rs. 300,000 sum insured for Taquee Ahmad and family members. 2) Details of insured persons, premium paid, and TPA information. 3) A note stating that 50% of pre-medical expenses will be reimbursed if the insured had undergone checks for the policy. 4) Contact information for customer service and a request to contact them if any queries arise.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    225 views3 pages

    HSAA188212000100

    Uploaded by

    Taquee Ahmad
    This document is an insurance policy document from Royal Sundaram General Insurance Co. Ltd. addressed to Taquee Ahmad. It includes: 1) An insurance certificate for a family health floater policy with Rs. 300,000 sum insured for Taquee Ahmad and family members. 2) Details of insured persons, premium paid, and TPA information. 3) A note stating that 50% of pre-medical expenses will be reimbursed if the insured had undergone checks for the policy. 4) Contact information for customer service and a request to contact them if any queries arise.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    Royal Sundaram General Insurance Co.

    Limited
    (Formerly Known as Royal Sundaram Alliance Insurance Company Limited)
    "Vishranthi Melaram Towers" No.2/319, Rajiv Gandhi Salai
    (OMR), Karapakkam, Chennai - 600097.
    Registered Office: 21, Patullos Road, Chennai 600 002.
    Toll: 1860-425-0000 Mobile: 94444 48899.
    email:[email protected], Website: www.royalsundaram.in
    IRDA Registration No.102 | CIN-U67200TN2000PLC045611

    January 23, 2019


    TAQUEE AHMAD
    H.NO-6 VASILA SOCIETY,KALITALAVADI
    BHARUCH
    BHARUCH
    GUJARAT
    392001
    Mobile No: 7600209081
    MN - MN-Bharuch Branch

    Re: HSAA188212000100 - S113


    Dear Customer,

    Thank you for choosing Royal Sundaram for your Health Insurance Plan.We are delighted to have you as
    our customer.
    We are enclosing the following documents pertaining to the above plan:

    • Schedule of Insurance
    • Terms & conditions
    • Know your Health Insurance - a guide to your policy and services provided
    • Personalized Health Cards for all members.

    Royal Sundaram provides its customers “Online Assistance” service, details of which are given in the guide
    enclosed.

    Please keep these documents in a safe place as they form part of our contract with you. We request you to
    verify the above documents and ensure everything is in order.

    At the first commencement date of the policy, at our request, if you have undergone pre-medical check-up for
    availing this Insurance, we shall be reimbursing 50% of the relevant medical expenses incurred by you, if you
    have opted for an annual cover . For cover more than one year we shall be reimbursing 100% of such
    expenses subject to the receipt being sent to us within 30 days from the receipt of this document. Please quote
    this Policy Number and send us the original receipt to process payment.

    Should you have any queries, you may contact our Customer Service Officers at the numbers mentioned
    below.

    Assuring you of our best services at all times.

    Yours sincerely,

    Duly Authorised Signatory

    ________________________________________________________________________________________
    Customer Services
    Call: 1860 425 0000, Email: [email protected]
    IRDAI/NL-HLT/RSAI/P-H/V.I/208/13-14
    Royal Sundaram General Insurance Co. Limited
    (Formerly Known as Royal Sundaram Alliance Insurance Company Limited)
    "Vishranthi Melaram Towers" No.2/319, Rajiv Gandhi Salai
    (OMR), Karapakkam, Chennai - 600097.
    Registered Office: 21, Patullos Road, Chennai 600 002.
    Toll: 1860-425-0000 Mobile: 94444 48899.
    email:[email protected], Website: www.royalsundaram.in
    IRDA Registration No.102 | CIN-U67200TN2000PLC045611

    FAMILY HEALTH FLOATER POLICY


    Certificate of Insurance

    Master Policy Number HLSBIL0029 AgencyCode OA500884


    Certificate Number HSAA188212000100 AgencyName SBI CARDS AND
    PAYMENT
    SERVICES P LTD
    Name of the Proposer TAQUEE AHMAD ContactNum / -39020202
    Address H.NO-6 VASILA Period of Insurance
    SOCIETY,KALITALAVADI
    BHARUCH
    From 00:00:00 hrs of 23/01/2019
    BHARUCH To 23:59:59 of 22/01/2020
    GUJARAT
    392001

    Floater Sum Insured :- 300000


    Nominee Name :- MD MOINUDDIN Relationship with Proposer :- FATHER
    Insured Person(s) details
    Name Relationship with Proposer Date Of Birth Pre Existing Disease(s)
    TAQUEE AHMAD SELF 04/03/1987 D29
    TPA Address Premium Details
    Premium ( ) 2092
    Medicare TPA Services (I) Pvt. Ltd., TPA Fees ( ) 87
    2, Paul Mansion, CGST ( ) 196
    6 Bishop Lefroy Road, SGST ( ) 196
    Kolkatta - 700020
    Toll Free No :- 1800 345 3322
    Total Amount ( ) 2571
    This Certificate forms part of the Terms and conditions attached herewith. Please quote the Certificate Number in all your correspondences.
    Income Tax Certificate
    This is to certify that Mr./Ms.TAQUEE AHMAD has paid 2571 towards Health Insurance for the above-mentioned persons under scheme approved
    by IRDA.This Certificate is issued for the purpose of claiming deduction under Section 80D of Income Tax Act, 1961.
    Master Policy is Duly Stamped .
    Provided that in the case of a policy of general insurance where the remittance made by the proposer or the policyholder is not realised by the
    insurer, the Policy shall be treated as void ab initio.
    IN WITNESS WHEREOF, this Certificate of Insurance has been signed at CHENNAI on January 23, 2019
    GSTIN. 24AABCR7106G1ZP PAN Number : AABCR 7106G
    For Royal Sundaram General Insurance Co. Limited,
    Duly Authorised Signatory
    This document is digitally signed, hence counter signature / stamp is not required.

    Disease Code Disease Description


    D29 GASRITIS
    4cf04ebde344522dc4f803ea12435689

    ________________________________________________________________________________________Signature
    Verified
    Not

    Customer Services Digitally signed by NIKHIL


    PRABHAKAR APTE
    Call: 1860 425 0000, Email: [email protected] Date: 2019.01.24
    15:12:49 IST
    Reason: For
    RoyalSundaram
    IRDAI/NL-HLT/RSAI/P-H/V.I/208/13-14 Location: Chennai
    Royal Sundaram General Insurance Co. Limited
    (Formerly Known as Royal Sundaram Alliance Insurance Company Limited)
    "Vishranthi Melaram Towers" No.2/319, Rajiv Gandhi Salai
    (OMR), Karapakkam, Chennai - 600097.
    Registered Office: 21, Patullos Road, Chennai 600 002.
    Toll: 1860-425-0000 Mobile: 94444 48899.
    email:[email protected], Website: www.royalsundaram.in
    IRDA Registration No.102 | CIN-U67200TN2000PLC045611

    GST Invoice
    Royal Sundaram General Insurance Co. Limited
    MN : MN-Bharuch Branch
    Address:
    Pelican III Floor, Abhishek Colony,Race Course circle
    BARODA - 390 007, GUJARAT
    GSTIN: 24AABCR7106G1ZP

    Policy Number : HSAA188212000100


    GST Invoice Number : HSAA18821200000
    Invoice Date : 23/01/2019

    Insured/Recipient Name and Address:


    TAQUEE AHMAD
    H.NO-6 VASILA SOCIETY,KALITALAVADI, BHARUCH
    BHARUCH
    State: GUJARAT
    Pincode: 392001
    Place of Supply: GUJARAT
    State Code : 24

    Accounting code of service :997133


    Accident and health insurance services

    Taxable Premium 2,179

    CGST 9% 196

    SGST 196
    9%

    Gross Premium 2,571

    Indication if tax payable under reverse charge - No

    Signature

    Note:This document is digitally signed

    This document is electronically generated. This document should be issued along with the Policy document. This document stands invalid, if
    issued separately

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