101

3 0000
0
30000
Date : 3 August 2015

Mr Rajeev Raj
Flat No 202 Plot No-5 H No- 1-33-41 Shradhha Appts
R T C Colony Trimulgherry Secunderabad
Secunderabad 500015
Andhra Pradesh

Policy No. : 10131258

Mobile No. : 7306940415

Subject : Renewal of Policy No. 10131258

Dear Mr Rajeev Raj,
We take this opportunity to thank you once again for entrusting us with your health; and assure you of our commitment to keep you
worry-free.hamesha.
We are pleased to confirm renewal of your policy; and enclosed are the following documents with regard to the same :
Policy Certificate
Premium Acknowledgement (including tax certificate)
To enjoy seamless services offered by your policy, please note the following :
- Renewal of this policy does not change or alter the Policy Terms and Conditions of Care.
- Health Cards and all other documents issued along with your first policy shall continue to be valid.
- To enable quicker processing, we request you to mention your Member Card Number / Policy Number in all future correspondence with us.
For any clarifications, please feel free to mail us at customerfirst@religarehealthinsurance.com or call us at 1800-200-4488.

Team Religare Health Insurance

5,137.16
719.20

Abhilasha Singh
2
0

for 1800
Clai

Policy Certificate

Mr Rajeev Raj

Flat No 202 Plot No-5 H No- 1-33-41 Shradhha Appts

R T C Colony Trimulgherry Secunderabad

Policy No.
Plan Name
Cover type
Policy Period - Start Date

10131258
Care

Policy Period - End Date

Premium Paid

Midnight 03-Aug-2016
Rs. 5856
(Premium 5,137.16 + Service Tax 719.20)
Single Premium

Secunderabad 500015
Premium Payment Mode

Andhra Pradesh

Floater
00:00 hrs 04-Aug-2015

Policyholder

Date of Birth

Client ID

Rajeev Raj

28-Sep-1985

51163713

Details of Insured
Name
Rajeev Raj
Abhilasha Singh

Client ID
51163713
51163714

Date of Birth

Relationship

28-Sep-1985 MEMBER
29-Dec-1988 SPOUSE

Insured with the

Company
Pre-existing diseases
(since)
04-Aug-2014 NONE
04-Aug-2014 NONE

*#No Claim
Bonus
30,000.00
30,000.00

*The No Claim Bonus shown in the Policy Certificate is provisional. The No Claim Bonus calculated on the Expiry Date, shall only be considered as final. However, in case of any change in provisional No
Claim Bonus, the same shall be intimated to the Policyholder by the Company through a separate endorsement.
#Subject to the Policy Terms&Conditions, the No Claim Bonus shown above would be available only up to the maximum amount of Rs. 30,000 for all the Insureds collectively.

Details of Cover
S No.

Particulars

Details

Sum Insured

Rs. 3,00,000

Benefits
S No.

Particulars

Hospitalization Expenses (Conditions for Medical Expenses)

Basis of Offering (On Annual Basis)

Upto Rs.3,00,000 (i.Room Rent = 1% of Benefit 1 Sum Insured per
day; ii.ICUCharges = 2% of Benefit 1 Sum Insured per day)

Pre-hospitalisation & Post-hospitalization Expenses

Pre-hospitalization upto 30 days; Post-hospitalization upto 60 days

Ambulance Cover

Upto Rs. 1,500 per Claim

Organ Donor Cover

Upto Rs. 50,000 per Policy Year

Domiciliary Hospitalization

Upto 10% of Sum Insured per Policy Year

Health Check-up

1 Check-up per adult, per Policy Year

Recharge of Sum Insured

1 re-instatement upto Sum Insured per Policy Year

Daily Allowance

Rs. 500 per day, maximum up to 5 days per Claim

No Claims Bonus

10% of Sum Insured for each Claim free year, maximum upto 50% of
Sum Insured; reduced by 10% of Sum Insured in case of Claim

0
1

Special Conditions
S No.

Particulars

Floater Cover

For Religare Health Insurance Company Limited

Authorized Signatory

Date of Issue : 03-Aug-2015

Place of Issue : Saket, New Delhi

Branch Details : RHICL, Saket, Delhi, Delhi - 110017 Branch Contact No. : 1800-200-4488

Correspondence Address:
Religare Health Insurance Company Limited
GYS Global, Plot No. A3, A4, A5,Sector-125,Noida,UP-201301 Contact No : 1800-200-4488 Fax:1800-200-6677
Website : www.religarehealthinsurance.com Email : customerfirst@religarehealthinsurance.com

03-Au

Consolidated Stamp Duty paid vide F.No.10 (17685)/COS(HQ)/CD dated 10th Jan 2015
Service Tax Registration No:AADCR628INSD001

IRDA Registration Number - 148

UIN: IRDA/NL-HLT/RHI/P-H/V.I/253/13-14

Registered office address : D-3, P3B, District Centre, Saket, New Delhi 110 017
CIN : U66000DL2007PLC161503
Note:
Attached with this Policy Certificate are the Policy Terms and Conditions and Annexures. Please ensure that these documents have been received, read and understood. If any of these documents have not
been received, please email at customerfirst@religarehealthinsurance.com or write to the Company. This Policy Certificate in original must be surrendered to the Company in case of cancellation of the
Policy.

RAJEEV RAJ
51163713
28-Sep-1985

ABHILASHA SINGH
51163714
29-Dec-1988

REN

Premium Acknowledgement

Policy No.
Client ID
Policyholder
Address

Policy Period

10131258
51163713
Mr Rajeev Raj
Flat No 202 Plot No-5 H No- 1-33-41 Shradhha Appts
R T C Colony Trimulgherry Secunderabad
Secunderabad 500015, Andhra Pradesh
04-Aug-2015 to 03-Aug-2016

Premium Details
Particulars

Amount (in Rs.)

Gross Premium
Care

5,8

5,137.16
V

Service Tax & Levies

Total

719.20
5,856.00

The Premium is rounded off to the nearest rupee.

Eligibility of Premium for Deduction u/s 80D of the Income Tax Act, 1961
This is to certify that Religare Health Insurance Co.Ltd. has received an amount of Rs. 5,856.00/- from Mr Rajeev Raj towards Payment of Health
insurance premium as per the details mentioned above. The premium paid for this policy is eligible for applicable tax benefits u/s 80D of the Income Tax
Act, 1961 and amendments thereof.

For Religare Health Insurance Company Limited

Authorized Signatory
This
Mr fro 513 towa

Date of Issue: 03-Aug-2015

Place of Issue: Saket, New Delhi

IRDA Registration Number - 148

Registered office address : D-3, P3B, District Centre, Saket, New Delhi 110 017
CIN : U66000DL2007PLC161503

Note
1)

In case of any discrepancy, the Policyholder is requested to contact the Company immediately.

2)

Any amount paid in cash towards the premium would not qualify for tax benefits as mentioned above.

3)

This document must be surrendered to the Company in case of Cancellation of the Policy or for the issuance of a fresh certificate in the case of any alteration in the Policy.

Religare Health Insurance Company Limited

Correspondence address : GYS Global, Plot No. A3, A4, A5, Sector - 125, Noida, U.P.-201301
Website : www.religarehealthinsurance.com
E-mail : customerfirst@religarehealthinsurance.com

UIN: IRDA/NL-HLT/RHI/P-H/V.I/253/13-14

Call Us : 1800-200-4488