Policy Schedule Report For Easy Health

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ANINDYA 24/2/16MANDAL PARA LANE POSINTHEE,KOLKATA 700050 WEST BENGAL,INDIA Kolkata 700050 West Bengal India Contact No.: Policy No. 110100/11001/1000411000

10-Aug-2013

Agency code:80128350

Your Health Insurance Coverage

Dear ANINDYA, Welcome to the Apollo Munich family and thank you for insuring with us. With reference to your application for a Health insurance cover, we are pleased to enclose the policy documents along with the cashless insurance card for all insured persons. The attached documents carry Unique Member Card Number and Unique Policy Number. To serve you better, we request you to indicate the same (Member Card Number / Policy Number) during all future correspondence with us. We would be happy to address any query you may have on our 24 hours toll free number and would be grateful to be of any assistance that you may require. Warm Regards,

Suraj Mishra Vice President - Operations & Customer Services

SCHEDULE - Easy Health Individual Standard Issuing Office : Agency Code : Policy Holder's Name : Policy Holder's Address : Policy Number : First policy inception date : Policy Period: From 00.00 am on 09-AUG-2013 Insured Persons Details:
RELATIONSHIP TO MEMBER ID INSURED PERSON'S NAME AGE POLICYHOLDER
Mr ANINDYA SUNDER 10005854621 BHATTACHARJEE 26 Policy Holder

Delhi Branch Office 80128350 ANINDYA 24/2/16MANDAL PARA LANE PO-SINTHEE,KOLKATA 700050 WEST BENGAL,INDIA Kolkata - 700050 West Bengal India 110100/11001/1000411000 09-AUG-2013 To 23.59 pm on 08-AUG-2014

SUM INSURED
100000

CRITICAL ILLNESS SUM INSURED

0

GROSS PREMIUM (RS)

1784.05

CUMULATIVE BONUS (RS)

0

Nominee Name SUNANDA BHATTACHARJEE

Relationship Mother

The nominee must be an immediate relative of the policyholder. For all other Insured Persons the policy holder shall be the nominee. Premium Calculation Net Premium : Discounts: Loadings : Service Tax : Duties and cess as applicable Gross Premium : (Rs) (Rs) (Rs) (Rs) (Rs) (Rs) 1587.80 0.00 0.00 190.54 5.72 1784.06

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Policy Schedule Report For Easy Health

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Gross premium amount (in words) : The stamp duty of Rs. 0.50/- (Paisa Fifty Only) paid. Service Tax Registration No.: AAGCA1654HST002 TPA details : Family Health Plan Limited

Rupees One Thousand Seven Hundred Eighty-Four and Paisa Six Only

For and on behalf of Apollo Munich Insurance Company Limited

Location : Gurgaon Date : 10-Aug-2013 Authorized Signatory

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