ORIENTAL BANK MEDICLAIM POLICY SCHEDULE

IRDA/NL-HLT/OIC/P-H/V.1/454/13-14
Policy No.

: 272900/48/2017/8894

Prev. Policy
No.

: 272900/48/2016/9253

Cover Note No.

: -

Cover Note Date

: -

Insured's Code

: 62173100

Issue Office Code : 272900

Insured's Name

: AJAY KUMAR JAIN

Issue Office Name : DO 29 New Delhi

Address

: F-268 GALI NO-10 SHASTRI PARK

DELHI-110053
-

Address

: 88, JANPATH,GROUND FLOOR NEW

DELHI
-

DELHI 110053
Tel. /Fax /Email

DELHI 110001

: 0 / / 8826480082 / NA

Tel. /Fax /Email

: 23324984 / 23325607 /
bipin@orientalinsurance.co.in

Agent/Broker Details
Dev.Off.Code : NA0000002674
Agent/Broker

: BF0000000861 OBC NEHRU PLACE DELHI CR :9904 BR : 217 - NEW DELHI-NEHRU PLACE

Address

: OBC NEHRU PLACE, NEW DELHI,DELHI,DELHI,110019

Tel/Fax/Email

: 23325607//NA

Period of Insurance : FROM 00:00 ON 28/07/2016 TO MIDNIGHT OF 27/07/2017

Collection No. & Dt. : CC 9284008113 - 11/07/2016
Gross Premium

5,144

Service Tax : 772

Stamp Duty

.5

Total

: 5,916

Co-insurance Details : NIL

TPA Details :
TPA ID
:
TPA Name

YA0000000348
M/s Medi Assist India
:

TPA Address :
Telephone No :

No.4/1, IBC Knowledge Park, Tower "D" 4th Floor,

Bannerghatta Road, Bangalore
BANGALORE 560029

Toll Free No

1800 425 9449

FAX No

Place :
Date :

11/07/2016

1800 425 9449

:

1800 425 9559

:

For and on behalf of

The Oriental Insurance Company Limited

This is an electronically generated document (Policy Schedule).The

Policy document duly stamped will be sent by post.
In case of any query regarding the Policy please call Toll
Free No. 1800 11 8485 and 011 33208485.
CIN: U66010DL1947GOI007158 All the Amounts mentioned in this policy are in Indian Rupees

General Manager
Authorised Signatory
Page 1 of 3

IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in

Attached to and forming part of policy number 272900/48/2017/8894

Risk Details
Sr No : 1

Emp : 17282191 Emp/Dependant : AJAY KUMAR

Name
ID
JAIN
008830

No Of
Dependants

SI : 400000

: 3

Particulars of the Persons covered

Sr. No.

Name

Relationship

Age

Sex

AJAY
KUMAR JAIN

Self

51

RITA JAIN

Spouse
Unemployed

47

RITIKA JAIN

Dependant Child

23

VIVEK JAIN

Dependant Child

22

Pre-existing Ailments, If
Any

Total Sum Insured in words : Indian Rupees Four Lakhs Only

Total Premium in words
: Indian Rupees Five Thousand Nine Hundred Sixteen Only
The insurance under this policy is subject to conditions, clauses, warranties,endorsements .
The policy shall pay for hospitalization expenses for medical/surgical treatment at any Nursing Home/Hospital in INDIA as
an in-patient defined in the policy
Warranted that in case the person covered under the policy has lodged any claim under the previous policy and the sum
insured is enhanced under the current policy, for a further claim for the same disease during the current policy, the earlier
Limit of Sum Insured shall be applicable and not the enhanced sum insured
Warranted that in case of dishonour of premium cheque(s) the Company shall not be liable under the policy and the policy
shall be void abinitio (from inception).
"We at Oriental continuously strive to ensure that you get the best possible treatment from our network hospitals.
Please contact your TPA or any of the Oriental offices for our preferred hospitals in your area before going for a
treatment. This will help us serve you in the best possible manner"
" FOR POLICY DETAILS PLEASE VISIT THE WEB SITES OF OIC OR OBC AT www.orientalinsurance.org.in or
www.obcindia.co.in "
In witness whereof the undersigned being authorised by and on behalf of the Company has/have herein to set his/their hands
at DO 29 New Delhi on 11-JUL-16
For and on behalf of
The Oriental Insurance Company Limited
Entered By

NA

General Manager
Authorised Signatory

Place :
Date :

11/07/2016

For and on behalf of

The Oriental Insurance Company Limited

This is an electronically generated document (Policy Schedule).The

Policy document duly stamped will be sent by post.
In case of any query regarding the Policy please call Toll
Free No. 1800 11 8485 and 011 33208485.
CIN: U66010DL1947GOI007158 All the Amounts mentioned in this policy are in Indian Rupees

General Manager
Authorised Signatory
Page 2 of 3

IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in

Attached to and forming part of policy number 272900/48/2017/8894

Place :
Date :

11/07/2016

For and on behalf of

The Oriental Insurance Company Limited

This is an electronically generated document (Policy Schedule).The

Policy document duly stamped will be sent by post.
In case of any query regarding the Policy please call Toll
Free No. 1800 11 8485 and 011 33208485.
CIN: U66010DL1947GOI007158 All the Amounts mentioned in this policy are in Indian Rupees

General Manager
Authorised Signatory
Page 3 of 3

IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in