Professional Documents
Culture Documents
Insurance Certificate
Mr. Sourav Baksi
17/ 1 A Sashi Bhusan Banerjee
Road,
Lic Market,
Behala Silpara Opp. Mamta
Jwelars,
Kolkata,
-,
West Bengal - 700008
Branch Office
Policy Number
Policy Commencement
Date
Policy Expiry date
Sum Insured (Rs.)
Loyalty Benefit
Total Sum Insured
Heartbeat Individual
Heartbeat Family Floater
Heartbeat Family First
Plan opted for
Policy Period
Renewal Due Date
NOC
30339144201501
From 18/06/2015 00:00 a.m.
To 17/06/2016 23:59 p.m.
5,50,000
Increase in Sum Assured
5,50,000
No
Yes
No
Heartbeat Gold 05 Lacs 2
Adults
1 year
17/06/2016
Premium Details
Net
Premium
(Rs.)
Service Tax
(Rs.)
Education
Cess (Rs.)
13,119.00
1,837.00
0.00
Insured Details
Name of the Insured
Person (s)
Age
Secondary
& Higher
Education
Cess (Rs.)
0.00
Gross
Premium
(Rs.)
14,956.00
28
Gender Relationship
with the
Policy Holder
M
Applicant
26
Spouse
Pre Existing
Condition#
Personal Waiting
Period*
None
None
None
None
Cover Details
Particulars
Individual Sum Insured (only in case of Family First)
Floater Sum Insured (only in case of Family First)
Sum Insured
Details
NA
NA
5,00,000
100
100
NA
Effective [Y/N]
Deductible
Optional Benefit/Feature
No
Nominee Details
Nominee Name
Mina Baksi
Relationship
Mother
Agent Details
Agent Name
NA
Agent
Code
NA
Agent
Agent
Agent Address
Contact No. Landline No
NA
NA
,
The stamp duty of Re.1 (Rupee one only) vide in challan no. F.10(16210)/ COS(HQ)/CD dated 16th October 2014
through e-stamp certificate No.IN-DL31147224239846M dated 10th November 2014.
Service Tax Registration No.: AAFCM7916HST001.
Somesh Chandr a
Chief Operations Officer & Chief Quality Officer