Welcome To Bajaj Allianz Family: Insured Name Policy Number Sumit Kumar Verma 12-8450-0000066186-03
Welcome To Bajaj Allianz Family: Insured Name Policy Number Sumit Kumar Verma 12-8450-0000066186-03
Welcome To Bajaj Allianz Family: Insured Name Policy Number Sumit Kumar Verma 12-8450-0000066186-03
It is our privilege to welcome you to the Bajaj Allianz General Insurance family.
We thank you for choosing Bajaj Allianz for your Insurance needs. We are one of India's leading general insurance companies with iAAA
rating from ICRA for the last ten consecutive years indicating the company's high claims paying ability and fundamentally strong
position in the industry. Please be assured that you have made right choice by choosing us and we will stand by you in your hour of
need.
Please find enclosed the policy schedule. We wish to inform you that the policy issued is based on the information submitted in the
proposal form as well as the acceptance of the terms and conditions, and this will be verified at the time of filing of claim. Request you
to kindly go through the same once again and in case of any disagreement, discrepancy or clarifications – write to us at
[email protected] within 15 days of the letter date.For policy wordings containing detailed terms, conditions and exclusions
of your insurance coverage follow below link
https://www.bajajallianz.com/download-documents/health-insurance/health-guard/Health-Guard-Policy-Wordings-print.pdf
Once again, we welcome you to the Bajaj Allianz family and look forward to a long association with you.
We assure you the best of our services and look forward to a continual patronage and association with you.
Authorized Signatory
Bajaj Allianz General Insurance Co. Bajaj Allianz House,Airport Road,Yerwada,Pune - 411 006. Reg. No.: 113 CIN: U66010PN2000PLC015329
www.bajajallianz.com http://www.linkedin.com/company/bajaj-allianz-general-insurance
Proposer Details
Proposer Name Sumit Kumar Verma
Proposer Address HPCL MUMBAI REFINERY B D PATIL MARG, MUMBAI, MAHARASHTRA, 400074, INDIA
Customer ID 114701301
Policy Details
Policy Number 12-8450-0000066186-03 Endorsement No NA
Sum Sum
CB(CB%) SCB Sum Insured Sum Insured Sum Insured Sum Insured Sum Insured
Insured Insured
Sumit Kumar 150000
300000 NA 5000 0 300000 0 3000 0
Verma (50%)
Add on Cover
Waiver of Room Capping Non-Medical Expenses Cover Health Prime Rider
Member Name
UIN: BAJHLA21577V012021 UIN: BAJHLAP21586V012021 UIN: BAJHLIA22169V012122
Premium Details
Description Amount(INR) Description Amount(INR)
"As per the GST regulations, the amount of GST will not be refunded if the policy / endorsement is cancelled after 30th September of the next
financial year E. & O.E"
"In case no GSTIN or incorrect GSTIN is provided by the Proposer at Proposal stage, Bajaj Allianz General Insurance Company Ltd shall not be
responsible for any Input Tax Credit losses and no subsequent revision of invoice will be undertaken."
“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.”
Exclusions
Member Name Exclusion
Additional Remarks NA
This is to certify that Sumit Kumar Verma has paid Rs.9558 towards Health Insurance premium for Period
and Policy Number as mentioned on the Policy Schedule and is eligible for Deduction under Section 80-D
of Income Tax (Amendment) Act, 1986
Notes:
80D Certificate 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.
3. In event of incorrect representation of this declaration the liability shall be upon the policy holder.
4. This certificate will not be valid if premium payment has been made in cash.
Receipt Number: 54-22-000001220490 Date: 11/03/2023 Premium Payer ID: 114701301 Float: NA;
Premium Payment Details Payment Frequency: Single Premium ** If Premium paid through Cheque, the Policy is void ab-initio in
case of dishonour of Cheque
Financial Institution Ref. No. NA
Stamp Duty
Rs.0.25/- This document is digitally signed,hence counter signature / stamp is not required
Principal Location : Bajaj Allianz House,Airport Road,Yerwada,Pune- 411006 PH-
66026666 | Services Accounting Code : 997133 Accident and health insurance services.
Authorized Signatory No reverse charge is payable on these services.
SUB 10022164 / NA
Our Insurance Expert will call you for hassle free renewal and industry best offers on your coverage
Bajaj Allianz General Insurance Co.Ltd. Bajaj Allianz House,Airport Road,Yerwada,Pune - 411006. Reg.No.:113 CIN:U66010PN2000PLC015329
www.bajajallianz.com http://www.linkedin.com/company/bajaj-allianz-general-insurance
Customer ID: 114701301 a total sum of Rupees Nine Thousand Five Hundred Fifty-Eight Rupees Only by,
Instrument Type Instrument No Instrument Date Bank Name Branch Name Amount (Rs.)
Note: Issuance of this receipt does not amount of acceptance of the risk by Bajaj Allianz General Insurance Company Limited. The insurance cover for
the risk shall be as per the terms and conditions of the Insurance Policy if and when issued.
*Cheque/DD/PO receipt is valid subject to realisation of the instrument
Authorized Signatory
Bajaj Allianz General Insurance Co.Ltd. Bajaj Allianz House,Airport Road,Yerwada,Pune - 411006. Reg.No.:113 CIN:U66010PN2000PLC015329
www.bajajallianz.com http://www.linkedin.com/company/bajaj-allianz-general-insurance
Cashless hospitalization in network hospitals can be obtained only if this card is produced along
with a letter of authorization from Bajaj Allianz except for emergency cases. This is subject to
terms and conditions of the policy. Please quote your ID number for assistance. Intimation to
Bajaj Allianz Helpline is mandatory in case of any hospitalization.
HOSPITAL ALERT: In emergency, Patient may approach with id card; please call Bajaj Allianz
helpline to verify coverage and cashless authorization.
Bajaj Allianz General Insurance Co.Ltd. Bajaj Allianz House,Airport Road,Yerwada,Pune - 411006. Reg.No.: 113 CIN: U66010PN2000PLC015329
www.bajajallianz.com http://www.linkedin.com/company/bajaj-allianz-general-insurance
This is to certify that Sumit Kumar Verma has paid Rs. 9558 towards Health Insurance premium for HEALTH GUARD -
INDIVIDUAL for the period from 15/03/2023 to midnight of 14/03/2024 under Policy no 12-8450-0000066186-03
2022-2023 9558.00
Authorized Signatory
This certificate must be surrendered to the company for issuance of fresh certificate in case of cancellation of the Policy or any alteration
in the insurance affecting premium.
Notes:
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.
3. In event of incorrect representation of this declaration the liability shall be upon the policy holder.
4. This certificate will not be valid if premium payment has been made in cash.
Policy Verification
Claim Registration
Bajaj Allianz General Insurance Co.Ltd. Bajaj Allianz House,Airport Road,Yerwada,Pune - 411006. Reg.No.:113 CIN:U66010PN2000PLC015329
www.bajajallianz.com http://www.linkedin.com/company/bajaj-allianz-general-insurance
Name (Proposer) Sumit Kumar Verma Name Bajaj Allianz General Insurance Company Ltd.
Address-1 Hpcl Mumbai Refinery B D Patil Marg Address-1 Office No 201 To 206,
Premium
Description Amount(INR) Description Amount(INR)
Authorized Signatory
Important Notes:
* The invoice is issued as per Section 31 of the CGST Act
* In case no GSTIN or incorrect GSTIN is provided by the Proposer at Proposal stage, Bajaj Allianz General Insurance Company Ltd shall not be responsible for
any Input Tax Credit losses and no subsequent revision of invoice will be undertaken
* As per the GST regulations, the amount of GST will not be refunded if the policy / endorsement is cancelled after 30th September of the next financial year E.
& O.E
“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.”
Bajaj Allianz General Insurance Co. Bajaj Allianz House,Airport Road,Yerwada,Pune - 411006. Reg.No.:113 CIN:U66010PN2000PLC015329
www.bajajallianz.com http://www.linkedin.com/company/bajaj-allianz-general-insurance