Policy No. Name Address:::: Track On / / M-5381

Track on / / M-5381
Policy No. : 0238585651 00

Name : Mr SURESH KUMAR PAL
Address : # 43 AXIS BANK VARTHUR MN RD
MARATHAHALL
BANGALORE - BANGALORE
KARNATAKA - 560037
9844278144
Dear Customer,
We are glad that you thought ahead and did the right thing by continuing your trust with Tata AIG MediCare,
0238585651. We value your relationship with us and appreciate your confidence in our services. We will not compromise
on your health insurance and neither should you. We will strive to serve you the best.
Please find the following documents along with letter in the parcel.
• Policy schedule
• Premium payment receipt
• 80d certificate
• Customer Information Certificate
For further queries you can visit our website www.tataaig.com or contact us on our Toll Free No.: 1800 266 7780/ For
Senior Citizens: 1800 22 9966.
For Tata AIG General Insurance Company Limited
Authorized Signatory
Insurance is the subject matter of the solicitation. For more details on risk factors, terms and conditions, please read sales brochure carefully before
concluding a sale.
TATA AIG General Insurance Company Ltd. Regd. Office: 15th floor, Tower A, Peninsula Business Park,Ganpatrao Kadam Marg, Off Senapati Bapat Marg, Lower Parel,
Mumbai 400013. IRDA of India Registration No.108, CIN No : U85110MH2000PLC128425, UIN No : TATHLIP23118V032223
Website: www.tataaig.com 24X7 Tollfree Helpline 18002667780 Email:[email protected]
Policy No. 0238585651 / M-5381 Page No. 1
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Policy
Schedule } Intermediary name : AXIS BANK LTD
Intermediary code : CA0069

Intermediary contact no. : 1800 209 2001(mobile or landline)
Issuing Office : WHITEFIELD

Client Id : 6008451798
Proposal no : 0235182329
Policy holder’s name : SURESH KUMAR PAL
Policy holder’s address : # 43 AXIS BANK VARTHUR MN RD

MARATHAHALL
BANGALORE,560037
BANGALORE KARNATAKA
9844278144
Insured GST No :
Place of Supply : KARNATAKA
Supply Code : 29
Policy Number : 0238585651 00
Product name Tata AIG MediCare
:
Plan type : Floater Basis
Policy period From 22/09/2023 00:00 hrs to 21/09/2024 on

:
11:59 PM
Business Type : RENEWAL BUSINESS
Policy Tenure : 1 Year
Premium Payment Zone : Zone B
concluding a sale.
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Insured Persons Details :

Member Insured Insured Date Age Relation- Restore Sum Insured Cumu- Accidental
ID person’s with TATA of Birth ship to Benefits (Rs.)# lative Death Sum
name AIG General proposer % Bonus Insured
Insurance (Rs.) (Rs.)
Co. Since
0011070672301 SURESH
22/09/2016 02/02/1972 51 Self 100 0.00
044 KUMAR PAL
0011070672302 SUJITH KUMAR

22/09/2016 08/02/2004 19 Son 100 500,000.00 250000.00 0.00
012 PAL
0011070672303 ANUSHKA
22/09/2016 20/11/2007 15 Daughter 100 0.00
008 KUMARI PAL
*For Family Floater policy, Sum Insured and cumulative bonus floats among the insured members of the family as mentioned above. This shall not be
applicable for newly added members in this policy.
# Sum Insured mentioned is excluding cumulative bonus. Earned cumulative bonus is separately mentioned
Nominee Details for Proposer:

Insured Name Nominee Name Relationship to Proposer
SURESH KUMAR PAL GIRIJA DEVE Wife
concluding a sale.
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Benefits table
Net Premium: (Rs) 23351.04
Cover Coverage
Discounts: (Rs) 9081.00
Loading: (Rs) 0.00
In-Patient Treatment Upto Sum Insured
UGST/SGST (9%): (Rs) 2101.59
Pre-Hospitalization expenses Upto 60 days CGST(9%): (Rs) 2101.59
IGST(18%): (Rs)
Post-Hospitalization expenses Upto 90 days
Gross Premium: (Rs) 27554.00
Day Care Procedures Upto Sum Insured Gross Premium amount(in words) : Rupees Twenty Seven
Thousand Five Hundred And Fifty Four and Paise 00 Only
Organ Donor Upto Sum Insured
Domiciliary Treatment Upto Sum Insured Claim Servicing Details:

n Name of Claim Administrator: TAGIC Health Claims
Global cover Upto Sum Insured
n Website: www.tataaig.com
Bariatric Surgery Cover Upto Sum Insured n Email: [email protected]
n Toll Free: 1800 266 7780 or 1800 229 966 (For
In-Patient Treatment - Dental Upto Sum Insured Senior Citizens)
n Claims TATA AIG General Insurance Company
Restore benefit Upto Sum Insured Administrator Limited,
Address: 5th and 6th Floor, Imperial Towers,
AYUSH Benefit Upto Sum Insured H.No 7-1-6-617/A, GHMC No - 615,616,
Upto Rs. 3000 per
Ameerpet, Hyderabad – 500016, Telangana.
Ambulance Cover
Hospitalization
Upto 1% previous year Stamp Duty Registration Details
Health Checkup Sum Insured; max.
The stamp duty of Rs.50.00/- paid in cash or demand draft or by pay
Rs.10,000 per policy
order,vide Receipt/Challan no:LOA/CSD/120/2023/3624/23 dated the
31/08/2023
Vaccination cover Upto Rs.5000 per policy
50% of actuals;
Hearing Aid maximum Rs.10,000
per policy
Daily Cash for choosing 0.25% of base Sum For Tata AIG General Insurance Co. Ltd.
Shared Accommodation Insured; maximum
(If applicable) Rs. 2000 per day
0.25% of base Sum
Daily Cash for Accompanying
Insured; maximum
an Insured Child Authorized Signatory
Rs. 2000 per day
In the event of non-realization of premium, the
Compassionate travel Upto Rs.20,000 Company shall not be liable under the policy and the
policy shall stand cancelled ab initio (from inception).
Upto Sum Insured per
Consumables Benefit
policy year
Policy Servicing Address :
Second Opinion Covered 2nd floor, JP & Devi Jambukeswar Arcade, No.69 Millers
8 teleconsultations (GP) Road, BANGALORE-560052 Tel No: 080-66272829
Wellness Service and Ambulance
Booking Facility.
All Room Categories
Room Category
Covered
concluding a sale.
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Specific Exclusion / loading if applicable

Member ID Insured Person’s Name Pre-Existing Disease Permanent Exclusion Loading Reason Effective date for
Exclusion/loading
Portability Details (If Applicable)

This Policy is in continuation with , for below mentioned members.
Previous Policy Name of previous Previous Insurer Sum Claim Details

Member name
Number insurer policy inception Insured if any
concluding a sale.
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Certificate of Premium payment for the purpose of declaration under Section 80 D of Income Tax
(Amendment) Act, 1961*
Date: 28/09/2023
Policy Number:0238585651
Customer Name:SURESH KUMAR PAL
GSTIN no.:
Dear Sir/Madam,
Sub: Tax Benefit Letter forTata AIG MediCare policy no. 0238585651
This is to certify that premium amount of Rupees Twenty Seven Thousand Five Hundred And Fifty Four Only for health
insurance Policy No 0238585651 issued to SURESH KUMAR PAL for the period 22/09/2023 to 21/09/2024 has been paid.
Receipt Illustration
Receipt ID. Name of Payer Mode of payment Amount paid

105121055691438 SURESH KUMAR PAL Online 27 554.00
Total Amount Paid 27 554.00
Premium illustration (Member wise)

Total member premium paid
Member ID Name of Member Relationship with Policyholder (Including Taxes & Loading)
0011070672301044 SURESH KUMAR PAL Self 16 119.46
0011070672302012 SUJITH KUMAR PAL Son 6 760.27
0011070672303008 ANUSHKA KUMARI PAL Daughter 4 674.50
Total Premium Paid (Inclusive of Loading & Taxes collected) 27 554.00
Please feel free to get in touch with us for any further help or queries at our 24x7 Helpline 18002667780
(Toll-free) or email us at [email protected]
We assure you of our best services at all times.

Regards,
For Tata AIG General Insurance Company Limited
Authorized Signatory
Date of Issue: 28/09/2023

Place of Issue:WHITEFIELD
*Note
1. Tax deductions can be claimed subject to the provisions prescribed in the relevant sections of the Income-tax Act, 1961 as
amended from time to time.
2. Premium paid in advance will be applied to the policy on premium due date.
3. This premium paid certificate is conditional upon credit in company's account post clearance of the instrument/facility
including electronic mode.
4. For any confirmation / impact analysis, customer is advised to refer the matter to his/her Tax consultant.
5. This certificate must be surrendered to the company in case of cancellation of this policy. In the event of incorrect
representation of this declaration the liability shall be upon the policyholder/payer.
concluding a sale.
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Receipt } Receipt No. : 105121055691438

Receipt Date : 06/09/2023
Policy No : 0238585651 00
Received with thanks from SURESH KUMAR PAL a sum of Rs. 27554.00 Rupees Twenty Seven Thousand Five Hundred Fifty
Four And Paise Zero Only Online
Gross Premium (`) Utilized from the receipt for policy (`) Balance (`)
27554.00 27554.00 0.00
Note:
1. This is a computer generated receipt and does not require a signature.
2. Upon issuance of this Receipt, all previously issued temporary receipts, if any, related to this Policy shall be
considered null and void.
3. Amounts received by cheque shall be subject to realisation.
4. Any amount received in excess of the Premium is being/shall be refunded by the Company.
GSTIN :29AABCT3518Q1ZS(GSTIN Number) KARNATAKA. Service Accounting Code : 997133
Revenue (consolidated) Stamp Duty duly paid vide challan No.LOA/CSD/47/2023/2581 date 22/05/2023 for applicable cases.
concluding a sale.
Tata AIG MediCare
Name : SURESH KUMAR PAL

Age : 51years,
M-5381 ( 1 to 0 )
Gender : Male
Policy No .: 0238585651
From : 22/09/2023
Member ID : 0011070672301044
Please refer to our website or mobile application to know the list of cashless
network hospitals and excluded hospitals
TAGIC Health Claims Tata AIG General Insurance Company Limited
th th
5 and 6 Floor, Imperial Towers, H.No 7-1-6-617/A, GHMC no - 615, 616, Ameerpet,
Hyderabad – 500016, Telangana, Toll Free: 18002667780, Website: www.tataaig.com
Tata AIG Medicare UIN: TATHLIP23118V032223
Tata AIG MediCare
Name : SUJITH KUMAR PAL

Age : 19years,
M-5381 ( 2 to 0 )
Gender : Male
Policy No .: 0238585651
From : 22/09/2023
Member ID : 0011070672302012
th th
Tata AIG MediCare
Name : ANUSHKA KUMARI PAL

Age : 15years,
M-5381 ( 3 to 0 )
Gender : Female
Policy No .: 0238585651
From : 22/09/2023
Member ID : 0011070672303008
th th
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Annexure to customer information sheet(CIS)- Benefit illustration in respect of policies offered on individual and family floater basis.
Age of the Coverage opted on individual Coverage opted on individual basis covering Coverage opted on family floater basis with
members basis covering each member of multiple members of the family under a single overall Sum Insured(only one sum insured
insured the family separately(at a single policy(Sum insured available for each member of available for entire family)
point of time) the family)
Premium (`) Sum Insured (`) Premium (`) Discount if Premium Sum Premium or Floater Premium Sum
any after Insured Consolidated discount after Insured (`)
Discount (`) premium for if any discount
(`) all members (`)
of the family
(`)
51 18973 28 % 13660.56
19 7957 28 % 5729.04 500000.00
15 5502 28 % 3961.44
Total Premium for all members of the Total Premium for all members of the family is Total Premium when policy is opted on floater
family is Rs____________when each Rs_________ when they are covered under a single basis is Rs 23351.04
member is covered separately policy
Sum Insured available for each Sum Insured available for each family member is Sum Insured of Rs 500000.00 is available for the
individual is Rs____________ Rs_________________. entire family
Note: Premium rates specified in the above illustration shall be standard premium rates without considering any loading. Also, the
premium rates shall be exclusive of taxes applicable.
concluding a sale.

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Track on / / M-5381

Policy No. : 0238585651 00

For Tata AIG General Insurance Company Limited

Intermediary code : CA0069

Issuing Office : WHITEFIELD

Policy holder’s address : # 43 AXIS BANK VARTHUR MN RD

Policy period From 22/09/2023 00:00 hrs to 21/09/2024 on

Insured Persons Details :

0011070672302 SUJITH KUMAR

Nominee Details for Proposer:

Domiciliary Treatment Upto Sum Insured Claim Servicing Details:

Specific Exclusion / loading if applicable

Portability Details (If Applicable)

Previous Policy Name of previous Previous Insurer Sum Claim Details

Receipt ID. Name of Payer Mode of payment Amount paid

Premium illustration (Member wise)

We assure you of our best services at all times.

Date of Issue: 28/09/2023

Receipt } Receipt No. : 105121055691438

27554.00 27554.00 0.00

GSTIN :29AABCT3518Q1ZS(GSTIN Number) KARNATAKA. Service Accounting Code : 997133

Name : SURESH KUMAR PAL

Name : SUJITH KUMAR PAL

Name : ANUSHKA KUMARI PAL

19 7957 28 % 5729.04 500000.00

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