This Document is Digitally Signed
The Oriental Insurance Company Limited Signer: ATUL JERATH
Date: Sun, Nov 29, 2020 20:08:16 IST
Location: NOIDA
Reason: Signing Policy for OICL
PNB-ORIENTAL MEDICLAIM POLICY-2017:Group Health Insurance Product(Policy for
Bank Account holders of PNB only) UIN:OICHLGP18074V011718
Policy No. : 222205/48/2021/660 Prev. Policy : 222205/48/2020/404
No.
Cover Note No. : - Cover Note Date : -
Insured's Code : 61723619 Issue Office Code : 222205
Insured's Name : ANIL KUMAR AGARWAL (GSTIN: 0) Issue Office Name : CBO5 KANPUR (GSTIN:
09AAACT0627R4ZU)
Address : 109/264, R K NAGAR KANPUR Address : 133/242 T P NAGAR NEAR BAKER
9415126001 GANJ CHAURAHA
KANPUR
-
-
KANPUR
KANPUR UTTAR PRADESH 208023
Tel. /Fax /Email : / / 9415126001 / Tel. /Fax /Email : 9793534766 ,7310336000 / /
[email protected] [email protected] Agent/Broker Details
Dev.Off.Code : NH0000000008
Agent/Broker : BC0000002349 PNB GUMTI NO. 5
Address : GUMTI NO. 5,KANPUR,UTTAR PRADESH,208001
Tel/Fax/Email : ////
Period of Insurance : FROM 00:00 ON 12/06/2020 TO MIDNIGHT OF 11/06/2021
Collection No. & Dt. : CC 9452000715 - 11/06/2020 GST INVOICE NO :0919103765 UIN :0
Gross Premium : 16,599 GST : 2,988 Stamp Duty : .5 Total : 19,587
Co-insurance Details : NIL
TPA Details :
TPA ID YA0000000338
: M/s Raksha Health In
TPA Name :
15/5, MATHURA ROAD, FARIDABAD
TPA Address : [email protected]; [email protected] 18001801444, 0129 -
FARIDABAD 121003 Toll Free No : 4289999, 2564377, 360
Telephone No : FAX No :
Place : KANPUR For and on behalf of
Date : 11/06/2020 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. Authorised Signatory
CIN: U66010DL1947GOI007158 All the Amounts mentioned in this policy are in Indian Rupees Page 1 of 3
IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in
This Document is Digitally Signed
The Oriental Insurance Company Limited Signer: ATUL JERATH
Date: Sun, Nov 29, 2020 20:08:16 IST
Location: NOIDA
Reason: Signing Policy for OICL
Attached to and forming part of policy number 222205/48/2021/660
Risk Details
Sr No : 1 Emp : A/C Emp/Dependant : ANIL KUMAR SI : 500000 No Of : 2
ID HOLDER Name AGARWAL Dependants
Particulars of the Persons covered
Sr. No. Name Relationship Sex Age Pre-existing Ailments, If
Any
1 ANIL KUMAR Self M 68
AGARWAL
2 MANJU Spouse F 65
AGARWAL Unemployed
3 YASH Dependant Child M 25
AGARWAL
Total Sum Insured in words : Indian Rupees Five Lakhs Only
Total Premium in words : Indian Rupees Nineteen Thousand Five Hundred Eighty-Seven 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
In the event of a claim under the policy exceeding Rs. 1 lac or a claim for refund of premium exceeding Rs. 1 lac,the
insured will comply with the provisions of the AML policy of the Company.The AML policy is available in all our operaing
offices as well as Company's website.
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"
In witness whereof the undersigned being authorised by and on behalf of the Company has/have herein to set his/their hands
at CBO5 KANPUR (GSTIN: 09AAACT0627R4ZU) on 29-NOV-20
Policy History Data
Policy No. Period From Period To Insurer Name Sum Insured
222205/48/2015/525 12-JUN-14 11-JUN-15 The Oriental Insurance Company Ltd. 500000
222205/48/2016/556 12-JUN-15 11-JUN-16 The Oriental Insurance Company Ltd. 500000
222205/48/2017/631 12-JUN-16 11-JUN-17 The Oriental Insurance Company Ltd. 500000
Place : KANPUR For and on behalf of
Date : 11/06/2020 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. Authorised Signatory
CIN: U66010DL1947GOI007158 All the Amounts mentioned in this policy are in Indian Rupees Page 2 of 3
IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in
This Document is Digitally Signed
The Oriental Insurance Company Limited Signer: ATUL JERATH
Date: Sun, Nov 29, 2020 20:08:16 IST
Location: NOIDA
Reason: Signing Policy for OICL
Attached to and forming part of policy number 222205/48/2021/660
222205/48/2018/692 12-JUN-17 11-JUN-18 The Oriental Insurance Company Ltd. 500000
222205/48/2019/476 12-JUN-18 11-JUN-19 The Oriental Insurance Company Ltd. 500000
222205/48/2020/404 12-JUN-19 11-JUN-20 The Oriental Insurance Company Ltd. 500000
Claim History Data
Policy No. Claimant Name Claim No. Claim OS Claim Paid
" In case of grievance related to any issue related to this policy the same may be addressed to the office In-Charge or the
Grievance Officer at above policy address. If the grievance remains pending, it may be escalated to Grievance Officer of the
concerned Regional Office 43, HAZRATGANJ,,LUCKNOW,,. The next escalation in case grievance remains unresolved is CSD,
Head Office, situated at Oriental House, A-25/27, Asaf Ali Road, New Delhi-110002.
If the insured is not satisfied with the resolution/reply provided by the company, he/she may approach the Office of Insurance
Ombudsman, within his/her jurisdiction. The list of offices of Ombudsman is available on Company 's portal. "
Entered By : [email protected]
For and on behalf of
The Oriental Insurance Company Limited
Policy Printed By :OICL IP :
Authorised Signatory
Policy Printed On : 29-NOV-20 20:08:05 MAC :
Place : KANPUR For and on behalf of
Date : 11/06/2020 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. Authorised Signatory
CIN: U66010DL1947GOI007158 All the Amounts mentioned in this policy are in Indian Rupees Page 3 of 3
IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in
