Renewal of Your Easy Health Floater Standard Insurance Policy

HDFC ERGO General Insurance Company Limited
2806203589750502000
Mr P G Krishnamurthy
58 C 4Th Cross Chamundivihar Layout
Nazarbad Mysore Karnataka - 570010
Contact No.: 9916642719
Email: [email protected]
Policy No : 2806 2035 8975 0502 000
Intermediary Code Intermediary Name Intermediary Contact Number

AGENT : SHIVAPRAKASH
201849538897 91-9845119267
BANNIKUPPE SHIVANANJAIAH
Renewal of Your Easy Health Floater Standard Insurance Policy
Dear Mr P G Krishnamurthy ,
Welcome to HDFC ERGO General Insurance Company Limited. We are pleased to issue you Renewal of Your Easy Health Floater Standard Insurance Policy.
We advise you to retain your Policy Kit during the entire term of the Policy (including renewals).
Please note that the Policy has been issued to you based on the declarations, details and documents received from/on behalf of you in/along with the Proposal
Form submitted to us.
Please visit our website www.hdfcergo.com for more information about our Company, Grievance handling and any other support. To know the updated list of our
network hospitals please visit https://www.hdfcergo.com/locators/cashless-hospitals-network
We value your relationship with us and assure you our best services at all times and we look forward to serve you.
Warm Regards,
Location: Mumbai
Authorized Signatory Date: 20/08/2022
Note:
1. Please update us with your latest contact details (in case of any change) so that same can be updated in our records.
2. You can either email us on [email protected] or call on our Customer care no. 022 6234 6234 / 0120 6234 6234.
3. *The Copy of the proposal form has been sent on your registered email id if policy is purchased through website.
Certificate for the purpose of deduction under Section 80 D of Income Tax Act, 1961*
This is to certify that the P G KRISHNAMURTHY has paid Rs. 30933 (Rupees Thirty Thousand Nine Hundred Thirty-Three And Zero Paise Only) towards
premium for Easy Health Floater Standard Policy No. 2806203589750502000 issued to P G KRISHNAMURTHY for period of 25/08/2022 to 24/08/2023.
For and on behalf of HDFC ERGO General Insurance Company Limited

Location: Mumbai
Date: 20/08/2022
Authorized Signatory
*Note
1. This is subject to the provisions of Section 80D of Income Tax Act, 1961 as amended from time to time.
2. 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 Policyholder.
3. Please note that this certificate will not be issued if the premium payment has been made in cash.
4. In case of dishonor of the premium instrument, the policy will be deemed cancelled ab initio.
5. 80D benefit is applicable for only Self, Spouse, Dependent Children and Dependent parents.
HDFC ERGO General Insurance Company Limited. IRDAI Reg. No. 146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg,
Churchgate, Mumbai–400 020. Policy Issuing/ Customer Happiness Center: D-301, 3rd Floor, Eastern Business District LBS Marg, Bhandup (West), Mumbai - 400 078. 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. Trade Logo displayed above belongs to HDFC Ltd and ERGO
International AG and used by the Company under license. UIN: Easy Health - HDFHLIP23024V072223 | Critical Advantage Rider - HDHHLIP21342V022021 | Hospital Daily Cash Rider - HDHHLIP21344V022021 |
Individual Personal Accident Rider - APOPAIP19004V011920 | Protector Rider - HDHHLIP21335V022021.
Policy Schedule - Easy Health Floater Standard
Policy Number 2806 2035 8975 0502 000

Policy Holder’s Name Mr P G Krishnamurthy
Policy Holder’s Address 58 C 4Th Cross Chamundivihar Layout Nazarbad Mysore Karnataka - 570010
Policy Holder State Name & Code Karnataka (29) Place of Supply KARNATAKA
GSTIN/ UIN (if any) of Policy Holder
First policy inception date 25/08/2010 Policy Issuance Date 20/08/2022
Policy Period From 00:01 hrs on 25/08/2022 To 24:00 hrs on 24/08/2023
2ND FLOOR, MYSORE TRADE CENTRE, OPP K S R T C BUS STAND, B N ROAD, MYSORE MYSORE Tel :
Issuing/Servicing Office
+91-821-3988360
GSTIN 29AABCL5045N1Z4
AGENT : SHIVAPRAKASH BANNIKUPPE
Intermediary Name Intermediary Contact No 91-9845119267
SHIVANANJAIAH
Intermediary Code 201849538897 Description/ Harmonized System Of Accident and Health insurance
Nomenclature Code Services/9971
Insured Person Details
Member 1 Member 2 Member 3 Member 4 Member 5 Member 6
PG Mrs H Manjula / Master Mayur Baby Madurya
Particulars / Member ID KRISHNAMURTHY 2020010000733788 Krishna / Krishna /
/ 2020010000733787 2020010000733786
2020010000733789
Date of Birth (Age) 14/05/1971 (51) 31/07/1973 (49) 01/09/1997 (24) 08/11/2001 (20) - -
Relationship to Policy Holder Self Wife Son Daughter - -
Base Sum Insured (`) 400000
Cumulative Bonus (`) 320000
Protector Rider
28360
Sum Insured (`)
Total Sum Insured (`) 748360
Other Riders and Benefits ( `)
Protector Rider Opted
Hospital Daily Cash Rider SI
-
(Max. 30 days)
Critical Advantage Rider SI
- - - - - -
($)
IPA Rider SI - - - - - -
Critical Illness SI - - - - - -
Other Riders Premium (`)
Protector Rider Premium
2383.1
(Rs.) if opted
Hospital Daily Cash Rider
-
Premium (Rs.)
Critical Advantage Rider
Premium(Rs.)
- - - - - -
Individual Personal Accident
- - - - - -
Rider Premium (Rs.)
Critical Illness Premium (Rs.) - - - - - -
Nominee Details
Nominee Name : Mrs H Manjula Relationship to Policyholder: Wife
The nominee must be an immediate relative of the policyholder. For all other Insured Persons the policy holder shall be the nominee.
Premium Calculation (`)
Net Premium 26214 CGST@9% 2359.5
Discounts 0 SGST/UTGST@9% 2359.5
Loadings 0 IGST@18% 0
Taxable Premium 26214 Any other Cess or Taxes 0
Gross Premium 30933
Gross Premium (in words) Rupees Thirty Thousand Nine Hundred Thirty-Three And Zero Paise Only
The stamp duty of Rs. 1/- ( Rupees One And Zero Paise Only ) paid vide e-stamp Certificate No. LOA NO. CSD/418/2022/3270 dated 27/07/2022.
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
Original for Recipient/ Duplicate for Supplier
Whether tax is payable on reverse charge basis: No
Exclusion(s) / Special Condition(s) (Refer the leaflet attached in the policy document w.r.t. exclusions) :
Member ID No. Name Exclusion Type Applicable Health Condition Exclusion Portability/ Renewal Benefit
on SI Duration
(Years)
202001000073378 P G KRISHNAMURTHY For Rs 400000(Rupees Four Lakhs)
9 Sec 6 A (i) and Sec 6 A (ii) Sec 6 A
(iii) of the policy wording is waived.
Policy Schedule - Easy Health Floater Standard
Exclusion(s) / Special Condition(s) (Refer the leaflet attached in the policy document w.r.t. exclusions) :
Member ID No. Name Exclusion Type Applicable Health Condition Exclusion Portability/ Renewal Benefit
on SI Duration
(Years)
202001000073378 Mrs H Manjula Permanent Exclusion 400000 FRACTURE 98 For Rs 400000(Rupees Four Lakhs)
8 TIBIA/FIBULA Sec 6 A (i) and Sec 6 A (ii) Sec 6 A
(LEG)_1 (iii) of the policy wording is waived.
202001000073378 Master Mayur Krishna For Rs 400000(Rupees Four Lakhs)
202001000073378 Baby Madurya Krishna For Rs 400000(Rupees Four Lakhs)
Claim Administrator : HDFC ERGO General Insurance Company Ltd For and on behalf of HDFC ERGO General Insurance Company Limited
Location: Mumbai Authorized Signatory

Date: 20/08/2022
"For detailed policy terms and conditions please visit our website https://www.hdfcergo.com/download/policy-wordings "
Terms and Conditions

(1) This card would be valid till your relationship with HDFC ERGO General Insurance
Policy No.: 2806203589750502000 Company Limited / This card is invalid if the policy is cancelled (2) In case of renewal please
refer original policy number (3) This card is issued for the purpose of identification only and does not
entail automatic cashless facility at the network hospital. (4) A photo ID issued b y any government
authority i s to be produced to avail cashless facility. (5) Please apply for cashless facility 48 hours prior
to admission in case of planned admissions and within 24 hours of admission in case of emergency.(6) All
Insured Name Gender terms and conditions of the policy would be applicable while processing your cashless request. (7) In case
P G Krishnamurthy M your cashless facility i s denied due to any reason, please submit the claim for reimbursement. Denial of
Mrs H Manjula F cashless facility does not indicate rejection of the claim. (8) Please read policy documents carefully for
detailed terms and conditions. For claim status visit help section on our web site www.hdfcergo.com.
Master Mayur Krishna M Alternatively you may write to us at [email protected].
Baby Madurya Krishna F
HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146 CIN: U66030MH2007PLC177117.
Registered & Corporate Office: 1st Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh
Marg, Churchgate, Mumbai – 400 020. Health Claim Services Address : HDFC ERGO General Insurance
Company Limited Stellar IT Park, Tower-1 , 5th Floor, C - 25, Noida, Sector 62, 201301, Uttar Pradesh.
Service No. 022-62346234/ 0120-62346234Email: [email protected] Logo displayed
above belongs to HDFC Ltd and ERGO International AG and used by the Company under license.
Member Name Mrs H Manjula

Health Condition FRACTURE TIBIA/FIBULA (LEG)_1
Health Conditions Elaboration
ICD CODE Description
S82.0 Fracture of patella
S82.1 Fracture of upper end of tibia
S82.2 Fracture of shaft of tibia
S82.3 Fracture of lower end of tibia
S82.4 Fracture of fibula alone
S82.5 Fracture of medial malleolus
S82.6 Fracture of lateral malleolus
S82.7 Multiple fractures of lower leg
S82.8 Fractures of other parts of lower leg
S82.9 Fracture of lower leg, part unspecified

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HDFC ERGO General Insurance Company Limited

Policy No : 2806 2035 8975 0502 000

Intermediary Code Intermediary Name Intermediary Contact Number

For and on behalf of HDFC ERGO General Insurance Company Limited

Policy Schedule - Easy Health Floater Standard

Policy Number 2806 2035 8975 0502 000

Policy Schedule - Easy Health Floater Standard

Location: Mumbai Authorized Signatory

Terms and Conditions

Member Name Mrs H Manjula

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