HDFC ERGO General Insurance Company Limited

Cancellation
12 Aug 2011 SUSANTA KUMAR SINGH C/O KISHOR CHANDRA SINGH AT POST KHAJURIPADA BAI KALPATHRA DISTRICT -CUTTACK orissa - 754009 ORISSA
Subject :

Cancellation of Health Insurance Reference No HN16032011000745

Dear

SUSANTA KUMAR SINGH,

This is with reference to your request for cancellation of the below mentioned policies:
Product Name Critical Illness Total Policy No 50644638 Refund Amount 1329.00 1329.00

We wish to inform you that as per your request, we have cancelled the policy from 09/07/2011 and prorata premium amount is credited to your HDFC Bank debit card / credit card account. In case you need any further assistance, please feel free to contact us on our helpline numbers mentioned below. Yours sincerely, For HDFC ERGO General Insurance Company Limited

Authorised Signatory

Insurance is the subject matter of solicitation.

6th Floor, Leela Business Park, Andheri Kurla Road, Andheri (East), Mumbai 400 059, Toll-Free No. 1800-2-700-700 Fax : 91 22 6638 3699 care@hdfcergo.com www.hdfcergo.com Registered Office : Ramon House, H.T. Parekh Marg, 169, Backbay Reclamation, Mumbai 400 020.