Registered Office: Reliance Centre, 19, Walchand Hirachand Marg,Ballard Estate ,
Mumbai - 400 001
Policy Issuing Office : Reliance General Insurance Co. Ltd.,
570, Naigaum Cross Road, Next to Royal Industrial Estate, Policy Servicing Branch Office : Reliance General Insurance Co. Ltd, Reliance General Insurance Co Ltd 202-21 2nd Floor MERCANTILE HOUSE Wadala (W), Mumbai 400031 KASTURBA GANDHI MARG New Delhi New Delhi 110001 Rel i ance Indi vidual Medi cl aim Poli cy Schedul e Name and Address of the Proposer : NILESH GAWAS 304 PARSHWANATH CHS., PATIL PADA, BADLAPUR THANE 421503 India Mobile No: 9867947775 Poli cy Number 1301722811000291 Detai ls of previous pol icy (i n case of renewal) Previous poli cy No. : 1302712811000291 Date of expiry : 25/12/2013 Sum Insured : As Indicated Below Period of Insurance : From 00:01 on 25/12/2013 to mid-night on 26/12/2014 Name of Insured Person Gender Date of Birt h Relat ionship wi th the Proposer Occupat ion Pre-Exi sting Illness Sum Insured (Rs) Domi cil iary Hospital isati on Limit (Rs) Amount of CB (Rs) Loading (%) Premium (Rs) NILESH GAWAS APARNA GAWAS Male Female 02/10/1981 31/03/1981 Self Spouse Others Others 50000.00 500000.00 555000.00 0 18110.00 * Where an Insured Person is added to this Policy, either by way of endorsement or at the time of renewal, the pre-existing disease clause,first year exclusion and 30 days waiting period is applicable considering such policy period as the first policy with us. * Policy would be considered as a fresh policy if there would be break of fiftee n or more days between the prevoius policy expiry date and current policy start date. * Any enhanced Sum insured during subsequent policy renewals will not be availab le for an illness, diseases, injury already contracted under the preceding polic y periods.All Waiting periods as defined in the policy shall apply for this enhanced limit fro m the effective date of enhancement of such Sum Insured. * This Insurance is subject to the terms and conditions of policy attached .The policy wordings with detailed terms , conditions and exclusions is available on our website www.reliancegeneral.co.in Special Conditions, if any :
Premium Detai ls Amount (Rs.)
Gross Premium 18,110.00 Service Tax (12% of Net Premium) 2173.20 Education Cess (2% of Service Tax) 43.46 Secondary and Higher Education Cess (1% of Service Tax) 21.73 Total Premium 20,348.00 (Service Tax Registrati on No: AABCR6747BST001) Consolidated Stamp duty Paid vide Receipt No.20984 dated 20/12/2013 ** ** Not applicable for the State of J ammu and Kashmir Note: In the event of dishonor of cheque, this policy document automatically sta nds cancelled from inception, irrespective of whether a separate communication i s sent or not. In witness whereof this policy has been signed at Mumbai on 27/12/2013 For any assistance with claims, please contact us on 1 800 3002 8282 (toll free) and 3989 8282 (local charges apply) or email us at services.rgicl@relianceada.c om TPA/Service Provider Detai ls TPA/Service Provider Name Paramount Health Services Pvt. Ltd.
Address Please Log on to www.paramounttpa.com for locating the nearest office f
or submission of claim documents 24X7 Cust omer Helpline Number 022-66620880/ (022) 6662 0880(TollFree) Fax Number (022) 2825 9543 /9743 Email i d contact.phs@paramounttpa.com ( For Insured Grievances & for any other queries) Premi um Certi fi cate Premium Certifi cat e f or the purpose of deduction under Sect ion 80-(D) of In come Tax (Amendment ) Act 1986. This is to certify that NILESH GAWAS has paid Rs. 20348 (TWENTY THOUSAND THREE H UNDRED FOURTY EIGHT) towards premium for Health Insurance for the Period From 00:01 on 25/12/2013 to Midnight of 26/12/2014 on Dec 17 2013 Poli cy Number : 1301722811000291 Date : 17/12/2013 Pl ace : Mumbai Note: This certificate must be surrendered to the Insurance Company for issuance of fresh certificate in case of cancellation of policy or any alteration in the insurance affecting the premium.