*274337274*

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory and Development Authority of India [IRDAI] vide Regd. No.113)
Regd. Office: Bajaj Allianz House, Airport Road, Yerwada, Pune 411006 (India)

Welcome to Bajaj Allianz Family

Policy issuing office and Correspondence address for communication by 4th Floor Turquoise, Nr. Panchvati Circle, CG Road, Ellisbridge,
policyholder for claim, service request, notice, summons, etc. Ahmedabad-380006 Phone No :079-26432000
Proposer Name PRADIP P VAGHASIA Policy Number OG-22-2202-8433-00000083

PRADIP P VAGHASIA
DIVYAMRUT, ASOPALAV PARK 2, OPP
PALM CITY, SADHU VASWANI ROAD,
PO Area - KALAVADROAD, RAJKOT,
KALAVADROAD, RAJKOT,
Pin - 360005
Customer ID : 217278958 *OG-22-2202-8433-00000083*

Dear Customer,

Thank you for choosing Bajaj Allianz General Insurer as your preferred insurer. Bajaj Allianz
General Insurance Company Limited, a consistently profitable insurer enjoys a reputation of
expertise, stability and strength. We are a customer focused market leader present in over 200
locations across India. As an organization we strive to understand the risk management needs of
our consumers and translate it into affordable products and services of global quality that deliver
value for money. Bajaj Allianz has an ISO Certified claims, Operations and Services processes and
has received iAAA rating for the last three consecutive years from ICRA Limited, an associate of
Moody's Investors Service, for claims paying ability. The rating indicates highest claims paying
ability and a fundamentally strong position in the industry.

We request you to kindly go through the contents of the policy schedule and the terms and
conditions. In case of any clarification or disagreement, please write to us at
[email protected] within fifteen days of receipt of this policy.

We assure you the best of our services and look forward to a continual patronage and association
with you.

For & on the behalf

Bajaj Allianz General Insurance Company Ltd.

Authorized Signatory

For help and more information: Page 1 of 13

Contact our 24 Hour Call Centre at 1800-209-5858, 1800-102-5858 (Toll Free)
Email: [email protected] , Website www.bajajallianz.com

Corporate Identification Number: U66010PN2000PLC015329 | Demystify Insurance http://support.bajajallianz.com

http://www.facebook.com/BajajAllianz http://twitter.com/BajajAllianz www.bit.do/bjazgi

 *274337274*

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory and Development Authority of India [IRDAI] vide Regd. No.113)
Regd. Office: Bajaj Allianz House, Airport Road, Yerwada, Pune 411006 (India)

GROUP HEALTH INSURANCE POLICY

FAMILY HEALTH CARE TRANSCRIPT OF PROPOSAL BAJHLIP21182V022021
Policy issuing office and Correspondence address for communication by 4th Floor Turquoise, Nr. Panchvati Circle, CG Road, Ellisbridge,
policyholder for claim, service request, notice, summons, etc. Ahmedabad-380006 Phone No :079-26432000
Proposer Name PRADIP P VAGHASIA Policy Number OG-22-2202-8433-00000083

Dear PRADIP P VAGHASIA,

We wish to inform you that the your contract will be based on the information and declaration given by you through telephonic
conversation / email / web-inputs / TAB or other means which would be considered as the final proposal, the transcript of
which is as follows:

You are requested to yourself reconfirm the same at your end. In case of any disagreement or objection or any changes with
respect to information mentioned below, we request you to please revert back within a period of 15 days from the date of your
receipt of this document. In case of our non-receipt of your disagreement or objection or any changes [as mentioned
hereinabove] with respect to information mentioned below, it shall be deemed that you have positively confirmed to us the
correctness of the below mentioned transcript and declaration. Where you disagree to any of information/contents of this
transcript, standard Terms or conditions, you have the option to return the original Policy stating the reasons for your
objection, and upon our receipt of original Policy together with your request to cancel the Policy, shall be entitled to a refund of
the premium paid, subject only to there being no claim made under the Policy and also subject to a deduction of the expenses
incurred by us and the stamp duty charges.

Personal Information
First Name PRADIP P VAGHASIA
Middle Name Last Name
Email Address [email protected] Mobile Number 7567694829
Date of Birth 30-OCT-86 Nationality
Pan No NA Unique Identity
(Aadhaar No.)
Salary Occupation
Marital Status Family Monthly
Income
Permanent Address Mailing Address
House No/ DIVYAMRUT, ASOPALAV PARK 2OPP PALM House No/ DIVYAMRUT, ASOPALAV PARK 2OPP PALM
Building No/ Flat CITY, SADHU VASWANI ROAD Building No/ Flat CITY, SADHU VASWANI ROAD
No No
Street/ Locality/ PO Area - KALAVADROAD, RAJKOT, Street/ Locality/ PO Area - KALAVADROAD, RAJKOT,
Landmark Landmark
State RAJKOT State RAJKOT
City KALAVADROAD City KALAVADROAD
Area KALAVADROAD Area KALAVADROAD
Pincode 360005 Pincode 360005

Q1.Has any of the persons to be insured suffer from/or investigated for any of the following?
Disorder of the heart, or circulatory system, chest pain, high blood pressure, stroke, asthma any respiratory conditions, cancer
tumor lump of any kind, diabetes, hepatitis, disorder of urinary tract or kidneys, blood disorder, any mental or psychiatric
conditions, any disease of brain or nervous system, fits (epilepsy) slipped disc, backache, any congenital/ birth defects/ urinary
diseases, AIDS or positive HIV,any accident or any other disease If yes, indicate in the table given below.
Ans. No
Q2. Do you or any of the family members to be covered have/had any health complaints/met with any accident in the past 4yrs
or prior to 4yrs and have been taking treatment/ hospitalization? Please provide the details & duration of illness along with
treatment taken in below table
Ans. No
To support our Go Green initiative, send policy copy link on registered mobile number / email id :NO
For help and more information: Page 2 of 13
Contact our 24 Hour Call Centre at 1800-209-5858, 1800-102-5858 (Toll Free)
Email: [email protected] , Website www.bajajallianz.com

Corporate Identification Number: U66010PN2000PLC015329 | Demystify Insurance http://support.bajajallianz.com

http://www.facebook.com/BajajAllianz http://twitter.com/BajajAllianz www.bit.do/bjazgi

 *274337274*

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory and Development Authority of India [IRDAI] vide Regd. No.113)
Regd. Office: Bajaj Allianz House, Airport Road, Yerwada, Pune 411006 (India)

GROUP HEALTH INSURANCE POLICY

FAMILY HEALTH CARE TRANSCRIPT OF PROPOSAL BAJHLIP21182V022021
Policy issuing office and Correspondence address for communication by 4th Floor Turquoise, Nr. Panchvati Circle, CG Road, Ellisbridge,
policyholder for claim, service request, notice, summons, etc. Ahmedabad-380006 Phone No :079-26432000
Proposer Name PRADIP P VAGHASIA Policy Number OG-22-2202-8433-00000083

Insured/ Gender Date of Birth Relation Height Weight Add On Cumulati Sum Nominee Name Nominee
Beneficiary Name with Cover ve Bonus insured relation
Insured Details (Floater with
Basis) Beneficia
ry
PRADIP P Male 30-OCT-1986 SELF 170 68 NA 0(0%) 500000 MANALI VAGHASIA SPOUSE
VAGHASIA
Details if Q1 &/or 2 NA
is Answered as YES
MANALI P Female 21-JUN-1988 SPOUSE 152 52 NA PRADIP VAGHASIA SPOUSE
VAGHASIA
Details if Q1 &/or 2 NA
is Answered as YES
NIRMAY VAGHASIA Male 20-JUL-2013 SON 120 19 NA MANALI VAGHASIA MOTHER
Details if Q1 &/or 2 NA
is Answered as YES

Kindly note that as the information/contents and declarations/confirmations provided by you as contained in this transcript is
the basis on which we have issued the Policy to you, we advise you to please ensure that you have provided/disclosed and or
not withheld any material facts/information and declarations, as Policy becomes Void ab-initio if material facts are not
provided/disclosed and or withheld and in such case no claim, if any, will be considered by us apart from forfeiture of the
premium.

A. Coverage Details:
1. Plan Name : Family Health Care : Gold
2. Period of Insurance : From: 29-MAY-2021 16:05 Hrs. To : 28-MAY-2022 Midnight
3. Previous Insurance Provider : NA
4. Previous Policy number : NA
5. Previous Policy expiry Date : NA

For help and more information: Page 3 of 13

Contact our 24 Hour Call Centre at 1800-209-5858, 1800-102-5858 (Toll Free)
Email: [email protected] , Website www.bajajallianz.com

Corporate Identification Number: U66010PN2000PLC015329 | Demystify Insurance http://support.bajajallianz.com

http://www.facebook.com/BajajAllianz http://twitter.com/BajajAllianz www.bit.do/bjazgi

 *274337274*

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory and Development Authority of India [IRDAI] vide Regd. No.113)
Regd. Office: Bajaj Allianz House, Airport Road, Yerwada, Pune 411006 (India)

GROUP HEALTH INSURANCE POLICY

FAMILY HEALTH CARE TRANSCRIPT OF PROPOSAL BAJHLIP21182V022021
Policy issuing office and Correspondence address for communication by 4th Floor Turquoise, Nr. Panchvati Circle, CG Road, Ellisbridge,
policyholder for claim, service request, notice, summons, etc. Ahmedabad-380006 Phone No :079-26432000
Proposer Name PRADIP P VAGHASIA Policy Number OG-22-2202-8433-00000083

B. EXCLUSIONS AND TERMS AND CONDITIONS:

The detailed list of exclusions, standard terms and conditions, including the exclusion of pre-existing ailments/diseases, were
fully explained to you and for full details thereof please refer to the Policy wordings:

Answer given by You: Yes, I/we have been explained in full the details of exclusions, standard terms and conditions including
the exclusion of pre-existing ailments/diseases and knowing the same I/we have opted and proposed for this Policy.

The contents of the proposal [transcript of proposal of you is this document] and connected documents have been fully
explained to him and you have fully understood the significance of the proposed contract basis which you have confirmed for
policy issuance.

In case of Disagreement or objection or any changes with respect to information, declarations, Terms and Conditions,
exclusions and contents mentioned hereinabove, please contact our toll free number & register your objections / changes /
disagreement to the contents of this transcript or you may also send us email or written correspondence at the following
details within a period of 15 days from date of your receipt of this transcript along with Policy.

DECLARATION:
1. I hereby declare, on my behalf and on behalf of all persons proposed to be insured, that the above statements, answers
and/or particulars given by me are true and complete in all respects to the best of my knowledge and that I am authorised to
propose on behalf of these other persons.

2. I understand that the information provided by me will form the basis of the insurance policy, is subject to the Board
approved underwriting policy of the insurerand that the policy will come into force only after full payment of the premium
chargeable..

3. I further declare that I will notify in writing any change occurring in the occupation or general health of the life to be
insured/proposer after the proposal has beensubmitted but before communication of the risk acceptance by the company.

4. I declare that I consent to the company seeking medical information from any doctor or hospital who/which at any time has
attended on the person to beinsured/proposer or from any past or present employer concerning anything which affects the
physical or mental health of the person to be insured/proposer andseeking information from any insurer to whom an
application for insurance on the person to be insured /proposer has been made for the purpose ofunderwriting the proposal
and/or claim settlement.

5. I authorize the company to share information pertaining to my proposal including the medical records of the
insured/proposer for the sole purpose of underwriting theproposal and/or claims settlement and with any Governmental
and/or Regulatory authority.

Toll free Number: 1800-103-2529, 1800-102-5858 and 1800-209-5858

Email address: [email protected]
Website: www.bajajallianz.com

Contact our Policy servicing branch at:

4th Floor Turquoise, Nr. Panchvati Circle, CG Road, Ellisbridge, Ahmedabad-380006 Phone No :079-26432000
**This is print of electronic records maintained by us in accordance with law and hence does not require signature.
Scrutiny No:274337274

For help and more information: Page 4 of 13

Contact our 24 Hour Call Centre at 1800-209-5858, 1800-102-5858 (Toll Free)
Email: [email protected] , Website www.bajajallianz.com

Corporate Identification Number: U66010PN2000PLC015329 | Demystify Insurance http://support.bajajallianz.com

http://www.facebook.com/BajajAllianz http://twitter.com/BajajAllianz www.bit.do/bjazgi

 *274337274*

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory and Development Authority of India [IRDAI] vide Regd. No.113)
Regd. Office: Bajaj Allianz House, Airport Road, Yerwada, Pune 411006 (India)

GROUP HEALTH INSURANCE POLICY

FAMILY HEALTH CARE TRANSCRIPT OF PROPOSAL BAJHLIP21182V022021
Policy issuing office and Correspondence address for communication by 4th Floor Turquoise, Nr. Panchvati Circle, CG Road, Ellisbridge,
policyholder for claim, service request, notice, summons, etc. Ahmedabad-380006 Phone No :079-26432000
Proposer Name PRADIP P VAGHASIA Policy Number OG-22-2202-8433-00000083

INSURANCE ACT, 1938 SECTION 41 - PROHIBITION OF REBATES

No person shall allow or offer to allow either directly or indirectly, as an inducement to any person to take out or renew or
continue an insurance in respect of any kind of risk relating to lives or property in India, any rebate of the whole or part of the
commission payable or any rebate of the premium shown on the policy, nor shall any person taking out or renewing a policy
accept any rebate, except such rebate as may be allowed in accordance with the published prospectus or tables of the insurer.
ANY PERSON IN BREACH OF COMPLYING WITH THE PROVISIONS OF THIS SECTION SHALL BE PUNISHABLE WITH FINE WHICH
MAY EXTEND TO RUPEES TEN LAKH.Bajaj Allianz General Insurance Co Ltd

Authorized signatory

For help and more information: Page 5 of 13

Contact our 24 Hour Call Centre at 1800-209-5858, 1800-102-5858 (Toll Free)
Email: [email protected] , Website www.bajajallianz.com

Corporate Identification Number: U66010PN2000PLC015329 | Demystify Insurance http://support.bajajallianz.com

http://www.facebook.com/BajajAllianz http://twitter.com/BajajAllianz www.bit.do/bjazgi

 *274337274*

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory and Development Authority of India [IRDAI] vide Regd. No.113)
Regd. Office: Bajaj Allianz House, Airport Road, Yerwada, Pune 411006 (India)

GROUP HEALTH INSURANCE POLICY

FAMILY HEALTH CARE POLICY SCHEDULE BAJHLIP21182V022021
Policy issuing office and Correspondence address for communication by 4th Floor Turquoise, Nr. Panchvati Circle, CG Road, Ellisbridge,
policyholder for claim, service request, notice, summons, etc. Ahmedabad-380006 Phone No :079-26432000
Proposer Name PRADIP P VAGHASIA Policy Number OG-22-2202-8433-00000083

PROPOSER DETAILS POLICY DETAILS

Policy Issued on 29-MAY-21
DIVYAMRUT, ASOPALAV PARK 2, OPP
PALM CITY, SADHU VASWANI ROAD, Period of From: 29-MAY-2021 16:05 Hrs.
Proposer Address PO Area - KALAVADROAD, RAJKOT, Insurance To : 28-MAY-2022 Midnight
KALAVADROAD, RAJKOT, Customer ID 217278958
Pin - 360005
Policy Status Issued
Previous Policy No. - Expiry Date -
Insured Member Details
Member Name Customer ID Gender Date Of Birth Age Relation Nominee Name & Relation
PRADIP P VAGHASIA 217278958 Male 30-OCT-1986 34 SELF MANALI VAGHASIA SPOUSE
MANALI P VAGHASIA 217278960 Female 21-JUN-1988 32 SPOUSE PRADIP VAGHASIA SPOUSE
NIRMAY VAGHASIA 217278961 Male 20-JUL-2013 7 SON MANALI VAGHASIA MOTHER
GSTIN / UIN Place of Supply/State Code/ Name
NA 24 - Gujarat
Company GST No.: Invoice No.:
24AABCB5730G1Z3 276921849/1
Company PAN:
AABCB5730G
Sum Insured & Cover Details
Inpatient Hospitalization Treatment Hospital Cash Waiver of Medical Tests
Cumulative
Sum Insured Per Day Benefit Sum Insured Yes/No
Bonus
5,00,000.00 0.00(0%) 500.00 15,000.00 Yes
Premium Details
Description Amount(INR) Description Amount(INR)
Base Premium 10,240.00
Net Premium 10,240.00
State GST (9%) 922.00
Gross Premium: Rupees Twelve Thousand Eighty Four Central GST (9%) 922.00
Only
Gross Premium 12,084.00

For help and more information: Page 6 of 13

Contact our 24 Hour Call Centre at 1800-209-5858, 1800-102-5858 (Toll Free)
Email: [email protected] , Website www.bajajallianz.com

Corporate Identification Number: U66010PN2000PLC015329 | Demystify Insurance http://support.bajajallianz.com

http://www.facebook.com/BajajAllianz http://twitter.com/BajajAllianz www.bit.do/bjazgi

 *274337274*

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory and Development Authority of India [IRDAI] vide Regd. No.113)
Regd. Office: Bajaj Allianz House, Airport Road, Yerwada, Pune 411006 (India)

GROUP HEALTH INSURANCE POLICY

FAMILY HEALTH CARE POLICY SCHEDULE BAJHLIP21182V022021
Policy issuing office and Correspondence address for communication by 4th Floor Turquoise, Nr. Panchvati Circle, CG Road, Ellisbridge,
policyholder for claim, service request, notice, summons, etc. Ahmedabad-380006 Phone No :079-26432000
Proposer Name PRADIP P VAGHASIA Policy Number OG-22-2202-8433-00000083

Inpatient Hospitalization Gold

Treatment: Plan
Name of Institution This is Group Health Insurance policy issued to Customer of P
Special Terms & Conditions NA
Member Name Special Condition Member level
PRADIP P VAGHASIA NA
Special Exclusions
MANALI P VAGHASIA NA
NIRMAY VAGHASIA NA
This is to certify that PRADIP P VAGHASIA has paid RS.12,084.00 towards Health Insurance for
80 D Certificate Period and Policy Number as mentioned on the Policy Schedule and is eligible for Deduction under
Section 80-D of Income Tax (Amendment) Act, 1986
Receipt Number : 2202-03164081 | Date : 29-MAY-21 | Premium Payer ID : 217278958 | Float : CF
Premium Details
** If Premium paid through Cheque, the Policy is void ab-initio in case of dishonour of Cheque
Financial Institution Ref. No. 15519928
Agency Code & Name 10057461/ANGEL FINANCIAL ADVISORS PVT. LTD.
Contact No. 02230950376 E-Mail [email protected]
For & on the behalf
Bajaj Allianz General Insurance Company Ltd.

This document is digitally signed, hence counter signature / stamp is not

Authorized Signatory required.
Consolidated Stamp Duty of Rs.0.5/- paid towards
Insurance Stamps vide Challan No.
MH014271630202021M Defaced No.
0000144047202122 dated 12-APR-21 timing
13:29:05 of General Stamp Office,Mumbai,India.
Principal Location : 4th Floor, Turquoise, Nr.
Panchvati Circle, C.G Road, Ellisbridge, Ahmedabad -
380006 PH:079-26432000 | Services Accounting
Code : 997133 - Accident and health insurance
services. No reverse charge is payable on these
services.
Schedule (1) | Printed on : 29-MAY-2021 04:54:19|SilentPrint|Web|Sub 10057461 / YAM 502

For help and more information: Page 7 of 13

Contact our 24 Hour Call Centre at 1800-209-5858, 1800-102-5858 (Toll Free)
Email: [email protected] , Website www.bajajallianz.com

Corporate Identification Number: U66010PN2000PLC015329 | Demystify Insurance http://support.bajajallianz.com

http://www.facebook.com/BajajAllianz http://twitter.com/BajajAllianz www.bit.do/bjazgi

 *274337274*

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory and Development Authority of India [IRDAI] vide Regd. No.113)
Regd. Office: Bajaj Allianz House, Airport Road, Yerwada, Pune 411006 (India)

GROUP HEALTH INSURANCE POLICY

FAMILY HEALTH CARE ANNEXURE
Policy issuing office and Correspondence address for communication by 4th Floor Turquoise, Nr. Panchvati Circle, CG Road, Ellisbridge,
policyholder for claim, service request, notice, summons, etc. Ahmedabad-380006 Phone No :079-26432000
Proposer Name PRADIP P VAGHASIA Policy Number OG-22-2202-8433-00000083

For help and more information: Page 8 of 13

Contact our 24 Hour Call Centre at 1800-209-5858, 1800-102-5858 (Toll Free)
Email: [email protected] , Website www.bajajallianz.com

Corporate Identification Number: U66010PN2000PLC015329 | Demystify Insurance http://support.bajajallianz.com

http://www.facebook.com/BajajAllianz http://twitter.com/BajajAllianz www.bit.do/bjazgi

 *274337274*

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory and Development Authority of India [IRDAI] vide Regd. No.113)
Regd. Office: Bajaj Allianz House, Airport Road, Yerwada, Pune 411006 (India)

GROUP HEALTH INSURANCE POLICY

FAMILY HEALTH CARE ANNEXURE
Policy issuing office and Correspondence address for communication by 4th Floor Turquoise, Nr. Panchvati Circle, CG Road, Ellisbridge,
policyholder for claim, service request, notice, summons, etc. Ahmedabad-380006 Phone No :079-26432000
Proposer Name PRADIP P VAGHASIA Policy Number OG-22-2202-8433-00000083

HEALTH & WELLNESS CARD

HEALTH & WELLNESS CARD

Customer ID : 217278958
Policy No : OG-22-2202-8433-00000083
ID Card No : 22-276921849
Valid Up to : 28-MAY-2022
PRADIP P VAGHASIA (34Yrs.)

Bajaj Allianz General Insurance Company Limited

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance
Regulatory and Development Authority of India[IRDAI] vide Reg No. 113)
Regd.Office: Bajaj Allianz House, Airport Road, Yerwada, Pune-411006 (India)
Cashless hospitalization in network hospitals can be obtained only if this card is
produced along with a letter of authorization from Bajaj Allianz except for emergency
cases. This is subject to terms and conditions of the policy. Please quote your ID number
for assistance. Intimation to Bajaj Allianz Helpline is mandatory in case of any
hospitalization.
HOSPITAL ALERT: In emergency, Patient may approach with id card; please call Bajaj
Allianz helpline to verify coverage and cashless authorization.
For help and more information:
Contact our 24 Hour Call Center at 1800-209-5858 (Toll Free), 30305858
(chargeable,add area code before this number in case of mobile call)
Email: [email protected], Website www.bajajallianz.com
Corporate Identification Number: U66010PN2000PLC015329

For help and more information: Page 9 of 13

Contact our 24 Hour Call Centre at 1800-209-5858, 1800-102-5858 (Toll Free)
Email: [email protected] , Website www.bajajallianz.com

Corporate Identification Number: U66010PN2000PLC015329 | Demystify Insurance http://support.bajajallianz.com

http://www.facebook.com/BajajAllianz http://twitter.com/BajajAllianz www.bit.do/bjazgi

 *274337274*

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory and Development Authority of India [IRDAI] vide Regd. No.113)
Regd. Office: Bajaj Allianz House, Airport Road, Yerwada, Pune 411006 (India)

GROUP HEALTH INSURANCE POLICY

FAMILY HEALTH CARE ANNEXURE
Policy issuing office and Correspondence address for communication by 4th Floor Turquoise, Nr. Panchvati Circle, CG Road, Ellisbridge,
policyholder for claim, service request, notice, summons, etc. Ahmedabad-380006 Phone No :079-26432000
Proposer Name PRADIP P VAGHASIA Policy Number OG-22-2202-8433-00000083

HEALTH & WELLNESS CARD

HEALTH & WELLNESS CARD

Customer ID : 217278960
Policy No : OG-22-2202-8433-00000083
ID Card No : 22-276921849A
Valid Up to : 28-MAY-2022
MANALI P VAGHASIA (32Yrs.)

Bajaj Allianz General Insurance Company Limited

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance
Regulatory and Development Authority of India[IRDAI] vide Reg No. 113)
Regd.Office: Bajaj Allianz House, Airport Road, Yerwada, Pune-411006 (India)
Cashless hospitalization in network hospitals can be obtained only if this card is
produced along with a letter of authorization from Bajaj Allianz except for emergency
cases. This is subject to terms and conditions of the policy. Please quote your ID number
for assistance. Intimation to Bajaj Allianz Helpline is mandatory in case of any
hospitalization.
HOSPITAL ALERT: In emergency, Patient may approach with id card; please call Bajaj
Allianz helpline to verify coverage and cashless authorization.
For help and more information:
Contact our 24 Hour Call Center at 1800-209-5858 (Toll Free), 30305858
(chargeable,add area code before this number in case of mobile call)
Email: [email protected], Website www.bajajallianz.com
Corporate Identification Number: U66010PN2000PLC015329

For help and more information: Page 10 of 13

Contact our 24 Hour Call Centre at 1800-209-5858, 1800-102-5858 (Toll Free)
Email: [email protected] , Website www.bajajallianz.com

Corporate Identification Number: U66010PN2000PLC015329 | Demystify Insurance http://support.bajajallianz.com

http://www.facebook.com/BajajAllianz http://twitter.com/BajajAllianz www.bit.do/bjazgi

 *274337274*

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory and Development Authority of India [IRDAI] vide Regd. No.113)
Regd. Office: Bajaj Allianz House, Airport Road, Yerwada, Pune 411006 (India)

GROUP HEALTH INSURANCE POLICY

FAMILY HEALTH CARE ANNEXURE
Policy issuing office and Correspondence address for communication by 4th Floor Turquoise, Nr. Panchvati Circle, CG Road, Ellisbridge,
policyholder for claim, service request, notice, summons, etc. Ahmedabad-380006 Phone No :079-26432000
Proposer Name PRADIP P VAGHASIA Policy Number OG-22-2202-8433-00000083

HEALTH & WELLNESS CARD

HEALTH & WELLNESS CARD

Customer ID : 217278961
Policy No : OG-22-2202-8433-00000083
ID Card No : 22-276921849B
Valid Up to : 28-MAY-2022
NIRMAY VAGHASIA (7Yrs.)

Bajaj Allianz General Insurance Company Limited

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance
Regulatory and Development Authority of India[IRDAI] vide Reg No. 113)
Regd.Office: Bajaj Allianz House, Airport Road, Yerwada, Pune-411006 (India)
Cashless hospitalization in network hospitals can be obtained only if this card is
produced along with a letter of authorization from Bajaj Allianz except for emergency
cases. This is subject to terms and conditions of the policy. Please quote your ID number
for assistance. Intimation to Bajaj Allianz Helpline is mandatory in case of any
hospitalization.
HOSPITAL ALERT: In emergency, Patient may approach with id card; please call Bajaj
Allianz helpline to verify coverage and cashless authorization.
For help and more information:
Contact our 24 Hour Call Center at 1800-209-5858 (Toll Free), 30305858
(chargeable,add area code before this number in case of mobile call)
Email: [email protected], Website www.bajajallianz.com
Corporate Identification Number: U66010PN2000PLC015329

For help and more information: Page 11 of 13

Contact our 24 Hour Call Centre at 1800-209-5858, 1800-102-5858 (Toll Free)
Email: [email protected] , Website www.bajajallianz.com

Corporate Identification Number: U66010PN2000PLC015329 | Demystify Insurance http://support.bajajallianz.com

http://www.facebook.com/BajajAllianz http://twitter.com/BajajAllianz www.bit.do/bjazgi

 *274337274*

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory and Development Authority of India [IRDAI] vide Regd. No.113)
Regd. Office: Bajaj Allianz House, Airport Road, Yerwada, Pune 411006 (India)

GROUP HEALTH INSURANCE POLICY

FAMILY HEALTH CARE ANNEXURE
Policy issuing office and Correspondence address for communication by 4th Floor Turquoise, Nr. Panchvati Circle, CG Road, Ellisbridge,
policyholder for claim, service request, notice, summons, etc. Ahmedabad-380006 Phone No :079-26432000
Proposer Name PRADIP P VAGHASIA Policy Number OG-22-2202-8433-00000083

For help and more information: Page 12 of 13

Contact our 24 Hour Call Centre at 1800-209-5858, 1800-102-5858 (Toll Free)
Email: [email protected] , Website www.bajajallianz.com

Corporate Identification Number: U66010PN2000PLC015329 | Demystify Insurance http://support.bajajallianz.com

http://www.facebook.com/BajajAllianz http://twitter.com/BajajAllianz www.bit.do/bjazgi

 *274337274*

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory and Development Authority of India [IRDAI] vide Regd. No.113)
Regd. Office: Bajaj Allianz House, Airport Road, Yerwada, Pune 411006 (India)

GROUP HEALTH INSURANCE POLICY

FAMILY HEALTH CARE RECEIPT
Policy issuing office and Correspondence address for communication by 4th Floor Turquoise, Nr. Panchvati Circle, CG Road, Ellisbridge,
policyholder for claim, service request, notice, summons, etc. Ahmedabad-380006 Phone No :079-26432000
Proposer Name PRADIP P VAGHASIA Policy Number OG-22-2202-8433-00000083

RECEIPT

Receipt Number 2202-03164081

Receipt Date 29-MAY-21
Business Channel BA

Received with thanks from PRADIP P VAGHASIA

(Customer ID : 217278958) a total sum of Rupees Twelve Thousand Eighty Four Only by,

Instrument Type Instrument No Instrument Date Bank Name Branch Name Amount
Online Payment 3324920 29/05/2021 NA NA 12,084
Total Amount 12,084.00
Note :
Issuance of this receipt does not amount of acceptance of the risk by Bajaj Allianz General Insurance Company Limited. The
insurance cover for the risk shall be as per the terms and conditions of the Insurance Policy if and when issued.
* Cheque/DD/PO receipt is valid subject to realisation of the instrument

For & on the behalf

Bajaj Allianz General Insurance Company Ltd.

Authorized Signatory

Regd. Office: Bajaj Allianz House, Airport Road, Yerwada, Pune - 411006

For help and more information: Page 13 of 13

Contact our 24 Hour Call Centre at 1800-209-5858, 1800-102-5858 (Toll Free)
Email: [email protected] , Website www.bajajallianz.com

Corporate Identification Number: U66010PN2000PLC015329 | Demystify Insurance http://support.bajajallianz.com

http://www.facebook.com/BajajAllianz http://twitter.com/BajajAllianz www.bit.do/bjazgi