HDFC ERGO General Insurance Company Limited 2822200176448502000
Policy Schedule
Policy No. 5261 6301 323 3102 5164
Critical Illness Policy 0
Proposer Name MR Ravindra kumar Premium Frequency Single
Correspondence C-50, Mahindra Enclave Shastri Nagar Permanent C-50, Mahindra Enclave Shastri Nagar
Address Ghaziabad, UP - 201002 Address Ghaziabad, UP - 201002
st
Period of Insurance 4 From Date & Time 08/12/2024 00:01 hrs To Date & Time 07/12/2025Midnight 1 Policy Inception 08/12/2019
Insured Person’s Details & Sum Insured
Insured’s Name Sum Insured Plan Date of Birth Pre Existing Disease
Shakuntala Devi 700000 Platinum 28/09/1955
Coverage Details
1. Heart Attack (Myocardial Infraction) 6. Coronery Artery Bypass Surgery 11. Aorta Graft Surgery
2. Stroke 7. Multiple Sclerosis 12. Cancer
3. Kidney failure 8. Alzheimer's Disease 13. Heart Valve Replacement
4. Primary Pulmonary Arterial Hypertension 9. Paralysis 14. Parkinson's Disease
5. Benign Brain Tumor 10. Major organ transplantation 15. End Stage Liver Disease
Premium Details ( ` )
Basic Premium 56,500.00
Loadings 0.00
Goods and Service Tax @ 18% 10,170.00
Total Premium 66,670.00
Payment Details
Cheque No./DD/Fund Transfer Date Bank Name
ERGO_CC_231223-01236376064100-SE 23/12/2024 Hdfc Bank Ltd
Special Conditions
Exclusions
List of Endorsements
Endt No Description Effective Date
For Claim Services Phone 18002001999 Fax no. 18602000600 E-mail [email protected]
Address 6th Floor, MBC Tower, Old No. 90, New No. 199, Luz Church Road, Mylapore, Chennai - 04.
For any other query call toll-free 1800 2 700 700 or email us at [email protected] or log on to www.hdfcergo.com
INSURER / LEAD INSURER : HDFC ERGO General Insurance Co.Ltd. 65%
Co-insurers : Apollo Munich Health Insurance Company Limited 35%
The policy i s valid subject to payment received b y us. I f the premium i s not realised the policy shall be void from inception. The Insurer and Co-insurer’s liability in respect of any payment that may be
due under this policy i s strictly limited to the % stated above, subject always to the sum insured o r that part of the sum insured that remains in respect of a claim. For the avoidance of doubt under this
co-insurance arrangement, the lead Insurer i s the Insurer for all policy purposes including but not limited to the collection of premium, policy administration, notices, policy and claims decisions and
the payment of claims.
Consolidated stamp duty for this Insurance Policy i s paid b y Demand Draft, vide Receipt/Challan no 116615201314 dated 31/10/2013 a s prescribed in Government Notification Revenue and Forest
Department No. Mudrank 2004/4125/CR 690/M-1, dated 31/12/2004.
Policy Issuing Office: Mumbai For HDFC ERGO General Insurance Company Ltd.
Agent Name :HDFC BANK LTD
Agent Code :201587086428 Tel No. : 91-22-28561818 Duly Constituted Attorney
The Policy wording attached herewith includes all the standard coverage offered b y the Company to its customers. Your entitlement for coverage/benefits shall be restricted to the coverage/benefits a s
mentioned in this policy schedule. For any clarification please call our toll free number.
Corporate Off.: 6th Floor, Leela Business Park, Andheri-Kurla Road, Andheri(E), Mumbai 400 059. Toll-Free No.1800-2-700-700 Fax 91 22 66383699 [email protected] www.hdfcergo.com
Registered Off.: Ramon House, H.T.Parekh Marg, 169, Backbay Reclamation, Mumbai 400 020, India.
