Mr Hazari Chauhan M 1/25,DLF Phase II,Gurgaon Gurgaon - 122002 Haryana India Contact No.

: 9999108154 Policy No: 900001/11119/6000066002 Dear Mr Hazari Chauhan,

Agency Code : 80091069 Agent Name : Portal Agent's Contact No :

17-Dec-2012

Your Optima Restore Insurance Coverage Welcome to the Apollo Munich Health family and thank you for insuring with us. With reference to your application for a Health insurance cover, we are pleased to enclose the policy document. The attached document carries a Unique Member Card Number and a Unique Policy Number. For details of the benefits covered under Optima Restore Individual plan opted by you, please refer to the Schedule of Benefits section in the attached policy document. To serve you better, we request you to indicate the same (Member Card Number / Policy Number) during all future correspondence with us. As an esteemed customer of Apollo Munich Health this policy comes to you with the following add on benefits to help you encash our expertise in healthcare and health insurance. We offer a unique service called 'Healthline' which helps you reach our health experts and avail, health-related counseling, individual referrals, and information related to health, nutrition and diet. This service is constantly augmented to cover further areas of health and wellbeing to include personalized health and wellness solutions. To avail this service please call our Healthline at 1800-102-0099, between 09:00-18:00 Hrs through Monday to Friday and quote your customer ID. Alternatively, you can log on to www.apollomunichinsurance.com and enter your ID and password to write to our experts by clicking on the 'Healthline' who will then assist you. We appreciate that your health is of supreme importance and therefore, to help you understand the status of your health we offer free Health Risk Assessment or HRA. To know more about it and avail the facilities, please click on the related link post log in to our website. You may also call us on the toll free number to know more about it. You can also avail a 6% discount on pharmacy purchases at Apollo Pharmacies on the production of your Apollo Munich Health ID card*. This Policy comes with a Free look option. For more details, Please refer to Policy Wordings. Please retain your policy wordings for current and future use. Any changes to the policy wordings at the time of renewal, post approval from the regulator, will be updated and available on our website www.apollomunichinsurance.com. We would be happy to address any query you may have on our 24 hours toll free number 1800-102-0333 and would be grateful to be of any assistance that you may require. Warm Regards,

Suraj Mishra Senior Vice President - Operations & Customer Services *as per Bengal Chemists & Druggists Association circular dated 01-May-2009, discounts are not applicable in the state of West Bengal

OPTIMA RESTORE POLICY SCHEDULE - Optima Restore Individual Issuing Office: Policy Holder's Name: Policy Holder's Address: Gurgaon Head Office Mr Hazari Chauhan M 1/25,DLF Phase II,Gurgaon Gurgaon - 122002 Haryana India 80091069 Portal 900001/11119/6000066002 17-Dec-2012 To 24.00 hrs on 16-Dec-2013
Age 28 Relationship to Policyholder Policy Holder Basic Sum Insured (Rs.) 500000 Multiplier Benefit (Rs) 0

Agency Code: Agent Name: Agent's Contact No: Policy Number: First policy inception date: Policy Period: From 00.00 hrs on 17-Dec-2012 Insured Persons Details:
Member ID 10004815646 Insured Person's Name Mr Hazari Chauhan

Relationship: Father Nominee Name: Vaggan Chauhan 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 Discounts Loadings Service Tax Duties and cess as applicable Gross Premium Gross premium amount (in words) (Rs) (Rs) (Rs) (Rs) (Rs) (Rs) 5609.00 0.00 0.00 673.08 20.19 6302.27

Rupees Six Thousand Three Hundred Two and Paisa TwentySeven Only

The stamp duty of Rs. 0.50/- (Paisa Fifty Only) paid vide No.F.10(783)/COS(HQ)/Con.duty/08. (Not applicable for the state of Jammu & Kashmir). Service Tax Registration No.: AAGCA1654HST002 TPA details: Family Health Plan (TPA) Ltd (L.No.13) For and on behalf of Apollo Munich Health Insurance Company Limited

Location: Gurgaon Date: 17-Dec-2012

Authorized Signatory

Certificate for the purpose of deduction under Section 80 D of Income Tax (Amendment) Act, 1986* This is to certify that Mr Hazari Chauhan has paid Rs 6302.27 (Rupees Six Thousand Three Hundred Two and Paisa TwentySeven Only ) towards premium for Optima Restore Individual Policy No 900001/11119/6000066002 issued to Mr Hazari Chauhan for period 17-Dec-2012 to 16-Dec-2013.

For and on behalf of Apollo Munich Health Insurance Company Limited

Location: Gurgaon Date: 17-Dec-2012

Authorized Signatory

* 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. 3. Please note that this certificate will not be issued if the premium payment has been made in cash.