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    Zudo (2w)

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    hemuuu
    This risk assumption letter summarizes a health insurance policy that was issued to Hemanath M. based on the details provided in his application. The policy provides coverage for Hemanath and his mother Meena. Key details include: - Policy number: 4128i/iH/1089144241/00/000 - Policy period: From April 1, 2022 to March 31, 2023 - Insured members: Hemanath (age 33) and Meena (age 68) - Annual sum insured: Rs. 100,000 - Premium amount paid: Rs. 52,739.16 The letter requests confirmation that the policy details are accurate and informs that non

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    Zudo (2w)

    Uploaded by

    hemuuu
    46 views4 pages
    This risk assumption letter summarizes a health insurance policy that was issued to Hemanath M. based on the details provided in his application. The policy provides coverage for Hemanath and his mother Meena. Key details include: - Policy number: 4128i/iH/1089144241/00/000 - Policy period: From April 1, 2022 to March 31, 2023 - Insured members: Hemanath (age 33) and Meena (age 68) - Annual sum insured: Rs. 100,000 - Premium amount paid: Rs. 52,739.16 The letter requests confirmation that the policy details are accurate and informs that non

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    zudo (2w)

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    This risk assumption letter summarizes a health insurance policy that was issued to Hemanath M. based on the details provided in his application. The policy provides coverage for Hemanath and his mother Meena. Key details include: - Policy number: 4128i/iH/1089144241/00/000 - Policy period: From April 1, 2022 to March 31, 2023 - Insured members: Hemanath (age 33) and Meena (age 68) - Annual sum insured: Rs. 100,000 - Premium amount paid: Rs. 52,739.16 The letter requests confirmation that the policy details are accurate and informs that non

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    46 views4 pages

    Zudo (2w)

    Uploaded by

    hemuuu
    This risk assumption letter summarizes a health insurance policy that was issued to Hemanath M. based on the details provided in his application. The policy provides coverage for Hemanath and his mother Meena. Key details include: - Policy number: 4128i/iH/1089144241/00/000 - Policy period: From April 1, 2022 to March 31, 2023 - Insured members: Hemanath (age 33) and Meena (age 68) - Annual sum insured: Rs. 100,000 - Premium amount paid: Rs. 52,739.16 The letter requests confirmation that the policy details are accurate and informs that non

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 4

    Risk Assumption Letter

    Date : 01 APR 2022


    Dear Sir / Madam,
    We thank you for placing your confidence with ICICI Lombard for your health Insurance needs.
    Please find attached herewith Policy No.: 4128i/iH/1089144241/00/000 which has been issued based on the
    details furnished by the applicant

    Name of the proposer: Hemanath.M

    Mailing Address: No.90a karumari amman koil street kamaraj nagar Avadi chennai -600071

    Mobile No.: 9094439463


    Telephone No.:
    Email ID: [email protected]

    Product Name: iHealth


    No. of Members : 2
    Policy Duration (years): 1
    Age of the eldest member 68
    (years):
    ­2015 Mar­2016
    Policy Period From 0 01 APR 2022 To 31 MAR 2023

    Insured Details
    Name of the Relationship with Age P r e- Existing Annual Sum Optional Add- o n S u b- Voluntary
    Insured(s) Proposer Y e a r M o n t h s illness/injury Insured Cover limit Deductible
    Hemanath Self 33 4 NA
    Meena Mother 68 3 NA 100000 None 0

    Please go through the details as furnished in the format and the policy document and confirm that same are in order.
    In case there are any discrepancies, you are request to write back to us immediately at
    [email protected] or contact at 24 hour helpline number 1800 2666 for necessary
    changes/rectification.
    In the absence of any communication from you in this connection within a period of 15 days of receipt of this letter,
    we would take it that the issued policy is in order and as per your proposal. Thereon, any non disclosure related to
    Pre­Existing illness/injury would result in rejection of claims and cancellation of policy
    Thanking You,
    Yours Sincerely,

    Authorised Signatory
    ICICI Lombard General Insurance Company Limited,IRDA Regn.No.115

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    ICICI Lombard Complete Health Insurance
    Policy Number : 4128i/iH/108915572/00/000
    ICICI Lombard General Insurance
    Company LTD., IRDA Regn. No. 115 ,
    ICICI LOMBARD HOUSE , 414, Policy Issued
    Policy Issuing Office 01-Apr-2022
    Veer Savarkar Marg, Near Siddhi On
    Vinayak Temple, Prabhadevi, Mumbai
    400 025
    Part I Of Schedule
    Details of Policy Holder/ Proposer:
    Contact No(s) (R):-
    Policy No. 4128i/iH/1089144241/00/000
    Mobile No 9094439463
    Policy From 00:00 hrs 01 APR 2022 To
    Name of the Applicant Hemanath.M
    Period Midnight 31 MAR 2023
    No.90a Karumari amman koil st,
    Kamaraj Nagar,
    Correspondence Avadi, Chennai -71 Email Address [email protected]
    Address
    Tamil Nadu - 600071
    ­ 400612
    Relationship of Nominee
    Name of Nominee - ­
    with Proposer
    Details of Family Members covered under the Policy :
    Name of the Date Of Age Annual Sum Pre-Existing Health Member ID Optional Add-on Sub- Voluntary
    Gender Relation
    Insured(s) Joining Years Months Insured illness/injury No. Cover limit Deductible
    M.Hemanath 01 Apr 2022 33 4 M Self None 102965007
    M.Meena 31 Mar 2023 68 3 F Mother 100000 None 102965008 None 0

    Premium Schedule :
    Secondary and
    Basic Premium Service Tax Education Cess Total Premium
    Plan Name Higher Education
    (Rs.) (Rs.) (Rs.) (Rs.)
    Cess (Rs.)
    Senior Health - i Health 52000.54 738.62 0 0 52739.16

    For ICICI LOMBARD GENERAL INSURANCE Service Tax Registration No. : GIS/MUMBAI-
    COMPANY LIMITED I/1528/2001
    Service Tax Code Number : AAACI7904GST001
    Category: General Insurance Business Services
    Authorised Signatory 00440005.
    Important Note :This schedule and the attached policy shall be read together as one contract or any word or
    expression to which a specific meaning has been attached in any part of this policy or of the schedule shall bear
    the same meaning wherever it may appear.
    IMPORTANT :Insurance benefit shall become voidable at the option of the Company, in the event of any untrue
    or incorrect statement, misrepresentation, non description or non-disclosure of any material particular in the
    Proposal Form/ personal statement, declaration and connected documents, or any material information has been
    withheld by beneficiary or anyone acting on beneficiary's behalf to obtain insurance benefit. Please note that any
    claims arising out of pre-existing illness/injury/symptoms is excluded from the scope of this policy subject to
    applicable terms and conditions. Refer to attached Part II and III of the schedule for the terms and conditions. All
    disputes are subject to the jurisdiction of competent courts of INDIA
    The stamp duty of Rs 1.00 paid in cash or by demand draft or by payorder,vide Receipt/Challan no. 4063856
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    In the event of a claim, please call our 24X7 tollfree number 1800 2666 or email us at
    [email protected].
    Please send the relevant documents to: ICICI Lombard Health Care,Plot No:12 ,ICICI Bank
    Towers ,Nanakramguda ,Gachibowli, Hyderabad ­ 500032
    ICICI Lombard General Insurance Company Ltd
    Corp Office:ICICI Lombard General Insurance Company LTD., IRDA Regn. No. 115 , ICICI
    LOMBARD HOUSE , 414, Veer Savarkar Marg, Near Siddhi Vinayak Temple, Prabhadevi, Mumbai 400 025
    Mailing Address:4th Floor, Interface 11, Off Malad Link Road, Behind Goregaon Sports Club, Malad(w),
    Mumbai­ 400064.
    Toll Free 24 X 7 Call Center No 1800­2666. E­mail :[email protected]

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    Premium Certificate
    For the purpose of deduction under section 80D of Income Tax amendment act, 1961 and any amendments
    made thereafter.
    To,
    M.Hemanath
    No.90 a Karumari amman koil street
    Avadi,
    KamarajChennai
    Nagar Avadi Chennai
    ­ 400612.
    Nadu -- 600071
    Tamil Nadu 600071
    This is to certify that the company has received the premium of Rs. 52739.16 for Health insurance coverage
    under the policy no 4128i/iH/1089144241/00/000 vide Cheque/credit card dated ­001 APR 2022

    The Product is eligible for deduction u/s 80 D of the Income Tax,1961 ad any amendments made there to.
    For ICICI Lombard General Insurance Company Limited,IRDA Regn.No.115

    Authorized Signatory
    Note:
    l This certificate must be surrendered to the Insurance Company in case of Cancellation of the policy. In

    the event of incorrect representation of this declaration, the liability shall be upon the policyholder.

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