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Family Medicare Policy 2014

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PROPOSER & POLICY DETAILS

.

Customer Id
.
Proposer Name
.
Phone
.
Mobile
.
E-mail
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.
.

1222867884
DR. MUKESH KUMAR

0413002816P100056612
01/04/2016, 00:00:00
.
31/03/2017, 23:59 Midnight
.
3413002815P100024288

Policy Number
Policy Start Date
.
Policy Expiry Date
.
Previous Policy Number
.
PAN Number of proposer
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9873453191
drmukeshortho@yahoo.co.in
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.

PROPOSER ADDRESS

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ISSUING OFFICE ADDRESS

Proposer Name : Mr. DR. MUKESH KUMAR

UNITED INDIA INSURANCE Co. Ltd.

DO VASANT VIHAR 46, BASANT LOK, NEW DELHI-110057
City
: NEW DELHI
District : NEW DELHI
State : DELHI
PinCode : 110057
Office Contact Details: 11- 26143226, 26145083, 26143201

SEC-C, POCKET-I, FLAT NO-1048, VASANT KUNJ-1, DELHIDIST. : DELHI, DELHI

City
: new delhi
District : SOUTH WEST
DELHI
State : DELHI
PinCode : 110070
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BUSINESS CHANNEL DETAILS

.
.

Channel Code
IRDA License Number
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60/AGD0066563
298360l

Channel Name
Contact Number

MUNISH VOHRA
9810602520(Mob),

INSURED PERSON DETAILS

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.

Insured Name

Date of Birth

.
.

Age / Gender

.
.

DR. MUKESH KUMAR

DR. LILLY SINGH
.
ANOUSHKA SINGH
.

01/04/1975
01/04/1976
.
01/04/2002
.

MAHIR SINGH
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41/ Male
40/ Female
.
14/ Female
.

24/06/2013

Occupation

Salaried
Salaried
.
Non Earning
.

2/ Male

Non Earning

Relationship
with Proposer
.
Self
.
Spouse
.
Daughter Unmarried
.
Son

Proof of
Identity
.
UID
.
N/A
.
N/A
.

ID Number

N/A
N/A
.
N/A
.

N/A

N/A

COVER DETAILS
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Name of Insured
.
DR. MUKESH KUMAR
.
DR. LILLY SINGH
.
ANOUSHKA SINGH
.
MAHIR SINGH
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.
.

Sum Insured
500000

Premium
14965

MEDICAL HISTORY DETAILS

.

Insured Name
.
.
DR. MUKESH KUMAR
.
.
DR. LILLY SINGH
.
.
ANOUSHKA SINGH
.
.
MAHIR SINGH
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Adverse Medical History/ Pre Existing Illness / Disease

None
None
None
None

Inception Date(1st Health Insurance Policy)

01/04/2010
.
01/04/2010
.
01/04/2010
.
20/03/2014
.

NOMINEE DETAILS
.

Insured Name
.
DR. MUKESH KUMAR
.
DR. LILLY SINGH
.
ANOUSHKA SINGH
.
MAHIR SINGH
Blank
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Nominee Name
DR. LILLY SINGH
.
DR. MUKESH KUMAR
.
MUKESH KUMAR
.
MUKESH KUMAR

Nominee Age

Relationship with insured(s)

Spouse
.
Spouse
.
Father
.
Father
.

.
.
.

TPA SERVICE
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E-MEDITEK TPA SERVICES LTD-Plot No. 577, Udyog Vihar, Phase-5, Gurgaon HARYANA PIN 122016
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PREMIUM DETAILS
.

13070
1
Premium
Receipt Number 11304130015112967113 Stamp Duty
.
.
.
.
.
.
1895
20/03/2016
Credit Card
Service Tax
Receipt Date
Payment Mode
.
.
.
.
.
.
14965
14965
AAACU5552CST001
Total Paid
Receipt Total
Service Tax Code
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.
.
.
.
GC201603200003827500
20/03/2016
Transaction ID
Transaction Date
.
.
.
.
FPNB4368190131
PG Transaction Code
Transaction Confirmation Date 20/03/2016
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.
NOTE: Warranted that in case of dishonor of the premium cheque, this document stands cancelled ab initio.
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IMPORTANT: Policy subject to terms and conditions of Health Insurance Policy and can be downloaded from the company's website
http://uiic.co.in/sites/default/files/uploads/downloadcenter/FAMILY MEDICARE POLICY_0.pdf

Date of Proposal and Declaration: 20/03/2016

IN WITNESS WHEREOF, the undersigned being duly authorized has hereunto set her/ his hand at this 20th of March2016
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Policy stamp defaced and retained at office
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For United India Insurance Company Limited

Client IP Address : 14.96.211.62

Print date & time: 20/03/2016 09:31:41 PM
.

Duly Constituted Attorneys

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This schedule is computer generated and does not require any seal or signature in original. The authenticity of the policy schedule
can be verified at www.uiic.co.in

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Premium Certificate for the purpose of deduction under Section 80-D of Income Tax (Amendment) Act, 1986.

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This is to certify that Mr. DR. MUKESH KUMAR

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has paid 13,070.00 (RUPEES THIRTEEN THOUSAND SEVENTY ONLY)

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towards Premium for MEDICLAIM INSURANCE for the period from 00:00:00 on 01/04/2016 To Midnight of 31/03/2017

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Policy No : 0413002816P100056612

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Date: 20/03/2016 Place: Chennai
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Note:
For and on behalf of
This Certificate must be surrendered to the Insurance Company for issuance of
UNITED INDIA INSURANCE Co. Ltd.
fresh certificate in case of cancellation of the policy or any alteration in the
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Insurance affecting the premium.
Authorised Signatory
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* This document is digitally signed document and does not require signature
* This is a system generated document and any manual alteration / correction / overwriting in the document will make it invalid.

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