HDFC ERGO General Insurance Company Limited

2856205879281800000
my: Optima Secure

2856205879281800000

2856

MR ANSHUL GARG

S / O DC GARG , 4
NARENDRA VIHAR. BALLUPUR ROAD , OPP .
SURBHI PALACE HOTEL , DEHRADUN , DEHRADUN
DEHRADUN G.P. UTTARAKHAND ,
DEHRADUN, UTTARAKHAND, 248001
Contact No. 98XXXXXXX0

Date :20/11/2023
Dear MR ANSHUL GARG

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

Your Health insurance policy reference no 2856205879281800000 is confirmed on the basis of the information and declaration given by you.
The details of coverage are mentioned in the enclosed policy schedule of insurance.

We value your relationship with us and assure you our best services at all times and we look forward to serve you.
Now you can view your policy details and health card at your fingertips. Download our Mobile App now and experience convenience today!!
As per recent directive by Insurance Regulator IRDAI, KYC verification has been mandated for all existing & new insurance customers.
To ensure that we comply with this guidelines, we are retrieving your KYC documents (Address proof and Photo) updated with Pan No from CERSAI portal. Rest assured, your
KYC details will be verified or retrieved for KYC purpose only.

Proposer details have been updated basis the information present in the KYC documents. If you find any detail which needs to be corrected, request you to create/ modify the
eKYC ID and place a request for endorsement.

Soft copy of the policy is valid for all purposes including claims.

For HDFC ERGO General Insurance Company Ltd.

Duly Constituted Attorney

HDFC ERGO General Insurance Company Limited

Dear MR ANSHUL GARG,

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

This is to certify that we have received an amount of ` 27630 towards premium from MR ANSHUL GARG for my: Optima Secure, Policy No. 2856205879281800000
issued to MR ANSHUL GARG for the period 10/11/2023 to 09/11/2024.

Member wise premium break up is as follows:

Insured Person’s Premium Details
Name of Insured Person Relation with policy Gender Date of Birth Premium Goods & Services Total Premium including
holder Tax (GST) GST
Anshul Garg Self Male 10/12/1976 5240.45 943.281 6183.73
Shikha Garg Spouse Female 20/11/1976 11645.43 2096.1774 13741.6
Gaurang Garg Son Male 05/10/2006 3341 601.38 3942.38
Vedang Garg Son Male 23/08/2009 3188.36 573.9048 3762.26

Note:
1. This is subject to the provisions of Section 80D of income tax (Amendment) Act, 1986 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
policy holder.

For HDFC ERGO General Insurance Company Ltd.

Date : 20/11/2023
Duly Constituted Attorney

HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN: HDFHLIP23123V022223. 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
 2856205879281800000
HDFC ERGO General Insurance Company Limited
Policy Schedule
my: Optima Secure
Optima Secure

2856205879281800000
Policy Number : 2856 2058 7928 1800 000 Issuance Date : 20/11/2023
Period of Insurance : From 10/11/2023 15:45 hrs To 09/11/2024 Midnight
Invoice No. : 205879281800000 Premium Frequency : Single
Policyholder Name : Mr Anshul Garg Policy Type : FAMILY Floater
MR ANSHUL GARG HSN Code : 997133 Premium Tier : Tier2
S / O DC GARG , 4 NARENDRA VIHAR. BALLUPUR ROAD , :
OPP . SURBHI PALACE HOTEL , DEHRADUN , DEHRADUN Place of supply : UTTARAKHAND Previous Policy
P/161311/01/2023/005326
DEHRADUN G.P. UTTARAKHAND , DEHRADUN, Customer Id : 100530533926 Renewal : No
UTTARAKHAND-248001
EIA No. : Not provided
Contact No : 98XXXXXXX0
PAN
Email ID : [email protected]
Intermediary Name Intermediary Code Intermediary Contact Number
MUKESH SINGH 201832345188 91-9639912132

Insured Person’s Details and Sum Insured - Optima Secure

Insured Person’s Relation with Gender Date of Nominee Name Relationship First Policy Base Sum Aggregate Plus Benefit Unlimited Overseas
Name policy holder Birth with Nominee Inception Insured Deductible Restore Add Travel
date (`) (`) on(Y/N) Secure
Anshul Garg Self Male 10/12/1976 Shikha Garg Spouse 21/10/2015 1000000 25000 0 Yes No
Shikha Garg Spouse Female 20/11/1976 21/10/2015 Yes No
Gaurang Garg Son Male 05/10/2006 21/10/2015 Yes No
Vedang Garg Son Male 23/08/2009 21/10/2015 Yes No
The nominee must be an immediate relative of the policyholder. For all other Insured Persons the policy holder shall be the nominee.
Unlimited Restore UIN No: HDFHLIA22188V012122 Optima Wellbeing UIN No:HDFHLIA24099V012324
Insured Person’s Details and Sum Insured – Add On Covers
Optima Well my: health Critical illness Add
IPA Rider my: health Hospital Cash Benefit Add on
Being on
Insured Person’s Name Sum Plan Sum Insured Hospital Cash Hospital Cash Companio Hospital Hospital Cash
Insured Benefit - Normal Benefit - ICU n Benefit Cash Global - Global
Room Opted

Special Conditions/ Exclusions

Name of Insured Person Exclusion/Exclusion Wavier Loading Reason Special Condition / Declared Pre-existing
Disease

Renewal Continuity Benefits

Sum Insured (`) Waiting Periods Remaining Waiting Periods Remaining Waiting Periods Remaining: (30
Name of Insured Person
(Pre-existing Diseases) (Specific Waiting Period) Days Waiting Period)

Portability Continuity Benefits

Name of Insured Person Previous Sum Insured inclusive Porting Benefits on Waiting Periods Waiting Periods Waiting Periods
Policy Year of Cumulative Bonus Sum Insured (`) Remaining (Pre-existing Remaining (Specific Remaining: (30 Days
(`) Diseases) Waiting Period) Waiting Period)
3 600000 600000 Waived Waived Waived
ANSHUL GARG
2 400000 400000 1 Year Waived Waived
3 600000 600000 Waived Waived Waived
SHIKHA GARG
2 400000 400000 1 Year Waived Waived
3 600000 600000 Waived Waived Waived
GAURANG GARG
2 400000 400000 1 Year Waived Waived
3 600000 600000 Waived Waived Waived
VEDANG GARG
2 400000 400000 1 Year Waived Waived

The Policy Wording attached herewith includes all the standard coverages offered by the Company to its customers. Your entitlement for coverage/benefits shall be restricted to the
coverage/benefits as mentioned in this Policy Schedule issued to you. Please read the Policy Wording in conjunction with the Policy Schedule. For any clarification, please call our
toll free number 022 - 6234 6234 / 0120 - 6234 6234.

For declared and accepted pre-exiting medical conditions, waiting period (s) shall apply per policy terms and conditions from 1st policy inception date of the policy,
fresh waiting period (s) shall apply on enhanced sum insured.
Premium Details (`)
Particulars ANSHUL GARG SHIKHA GARG GAURANG GARG VEDANG GARG
Base Premium (A) 6952.5 15450 4432.5 4230
Optional Cover Premium (B) 0 0 0 0
Add on Cover Premium (C) 26.07 57.93 16.62 15.86
Loading (D) 0 0 0 0
Total Premium (E=A+B+C+D) 6978.57 15507.93 4449.12 4245.86
Aggregate Deductible Discount 1738.12 3862.5 1108.12 1057.5
Online Discount 0 0 0 0

HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN: HDFHLIP23123V022223. 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 2856205879281800000

Particulars ANSHUL GARG SHIKHA GARG GAURANG GARG VEDANG GARG

Employee Discount 0 0 0 0
Loyalty Discount 0 0 0 0
Family Discount 0 0 0 0
Long term Policy Discount 0 0 0 0
Total Discount (F) 1738.12 3862.5 1108.12 1057.5
Total Premium excluding GST (E-F) 5240.45 11645.43 3341 3188.36
GST 18% : Central Tax 9% ( `2107.5 ) + State Tax 9% ( `2107.5) 943.281 2096.1774 601.38 573.9048
Total Premium including GST 6183.73 13741.6 3942.38 3762.26
Payment Details
Instrument details 902000151309484 Date 08/11/2023 Bank Name BizDirect

Processing Centre
HDFC ERGO General Insurance Co. Ltd. , Stellar IT Park, Tower-1, Fifth Floor, C - 25, Sector 62, Noida - 0120 398 8360
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 noLOA/CSD/547/2022/5450/22 dated 22/12/2022 as prescribed in Government of Maharashtra Order No. Mudrank-2017/CR.97/M-1, dated the 09th
January 2018. GST Registration No: 05AABCL5045N1ZE". GST 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 :dehradun - 3rd floor, ncr developers, 24a cantt road, dehradun dehradun
For HDFC ERGO General Insurance Company Ltd.

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: HDFHLIP23123V022223. 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 2856205879281800000

SCHEDULE OF BENEFITS
Section* Plans Optima Secure
All figures Geography
India Only
in (`)
2 Base Sum Insured per Insured Person per Policy
1000000
Year (in Lakh)
1.1. Hospitalization Expenses Covered
1.1.a. Room Rent At Actuals
1.1.1.h. Road Ambulance Covered upto sum insured
1.1.1.i. Dental Treatment Covered upto sum insured
1.1.1.j. Plastic surgery Covered upto sum insured
1.1.1.k. Day Care Treatment Covered upto sum insured
1.2. Home Healthcare Covered upto sum insured
1.3. Domiciliary Hospitalization Covered upto sum insured
1.4. Ayush Treatment Covered upto sum insured
1.5. Pre-Hospitalization 60 days
1.6. Post-Hospitalization 180 days
1.7. Organ Donor Expenses Covered upto sum insured
2.1. Emergency Air Ambulance Covered Up to 500000
2.2. Daily Cash for choosing Shared Accommodation 800 per day max up to 4800
2.3. Protect Benefit Covered upto sum insured
2.4. Plus Benefit Bonus of 50% of the Base Sum Insured, maximum upto 100%.
2.5. Secure Benefit Equal to 100% of Base sum insured
2.6. Automatic Restore Benefit Equal to 100% of Base sum insured
2.7. Aggregate Deductible 25000
2.8. E-Opinion for Critical Illness In India
Preventive Health Check-up
3.
Sum Insured 10 Lakhs 1000000
Floater Policy* 5000

*For Individual policy sum insured and limits mentioned in the table are applicable on per Insured Person per Policy Year basis and for Family Floater policy sum insured and limits
apply on per policy per Policy Year basis
*Claims shall be payable as per geography mentioned in the above table unless explicitly stated otherwise in a specific cover.
#Aggregate Deductible & Overseas Travel Secure are not an inbuilt feature in any of the above Plans. However, these cover can be separately opted at inception of the Policy or at
subsequent Renewals. Aggregate Deductible if opted, shall apply only for claims arising in India. However, a Per Claim Deductible of Rs. 10,000 will apply separately for each and
every claim arising out of India in Global plans
*Preventive Health Check-up benefit will not be available under the policy if Aggregate Deductible of INR 5 Lakhs or more is in force

HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN: HDFHLIP23123V022223. 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 2856205879281800000

HDFC ERGO General Insurance Company Limited 4

Policy No.:2856205879281800000 This card is for identification purpose only.
Valid From: 10/11/2023 Renewal Date: 9 November
Card has to be presented to the Network Service Provider at the time of admission/ availing
Insured Name Member ID Date Of Birth Gender cashless hospitalization o r any other services. Insurance claim will be processed in accordance
ANSHUL GARG 2023310033660096 10/12/1976 Male with the policy term & conditions. Card does not guarantee cashless hospitalization or any other
SHIKHA GARG 2023310033660097 20/11/1976 Female service. For more details and updated list of Network Service Provider please refer our website or
GAURANG GARG 2023310033660098 05/10/2006 Male call our call centre. This card is valid till the time policy is active.
VEDANG GARG 2023310033660099 23/08/2009 Male
Customer Service No : 022 - 6234 6234 / 0120 - 6234 6234
Email : [email protected]
Processing Centre : HDFC ERGO General Insurance Company Ltd. 5th
floor,Tower 1, Steller IT Park, C-25,
Sector-62,Noida-201301.
Website : www.hdfcergo.com

HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN: HDFHLIP23123V022223. 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