0 ICICI 6 Lombard

Nibha ye Vaade

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Tax Certificate
Tax Certificate
1

TO
To
ASHOK DANGWAL
ANUJ RAKHEJA
1766/6,
Vill. IST FLOOR,
1ST
Lalpani, P.O GOVINDPURI EXTENSION,
- Kumbhichaur, KALKAJI,
Kotdwara
DELHI
Pauri GarhwaI
DELHI - 110019 - 246149
Uttarakhand

Subject: Premium
Subject: Premium certificate
certificate forpurpose
for the the purpose of deduction
of deduction under80D
under section section 80D Tax
of Income of Income
Act, 1961Tax
andAct,
any1961 and
any amendments
amendments made thereafter.
made thereafter.

Dear ASHOK
Dear ANUJ DANGWAL
RAKHEJA,

This
This is is to certify
to certify that
that the the Company
Company has receivedhas
the received the May
premium dated premium dated
24, 2017 Apr insurance
for Health 13, 2018coverage
for Health
insurance
under "Health coverage under
”Health Insurance Policy" "Health Insurance
Policy” with the following details. Policy" with the following details.

Policyholder's Name ANUJ

ASHOKRAKHEJA
DANGWAL Policy Number 4128i/iHPA/131205084/00/000
4128i/iHPA/131105175/00/000
Policy Start Date Apr 13, 2017
May 24, 2018 Policy End Date Apr 12, 2018
May 23, 2019
Plan Name iHP_Individual_Adult_1Year
iHP_lndividual_Adult_lYear
iHP_lndividual_Adult_1Year Total Premium Paid (`)
R) 12093
23173

800 of the Income Tax, 1961

The product is eligible for deduction u/s 80D 1961 and any amendments made there to.

GIS/MUMBAI-I/1528/2001
GlS/MUMBAl-l/1528/2001
Service tax registration number: GIS/MUMBAI-I/1528/2001

Note: This certificate must be surrendered to the Insurance Company in case of Cancellation of the Policy. In the
event of incorrect representation of this declaration, the liability shall be upon the policyholder.

109/20150914/284
109/201 50914/284
109/20150914/284

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: U67200MH2000PLC129408 ICICI Lombard Complete Health Insurance UIN |RDAI/HLT/ICICI/P-H/V.Il/63/15—16
IRDAI/HLT/ICIC|/P-HN.||/63/15-16
UIN - IRDAI/HLT/ICICI/P-H/V.II/63/15-16
Mailing Address: Registered Office: Toll free no.:
no.: 1800
1800 2666
2656
401
401 &
8 402, 4th Floor, Interface 11,
Er ICICI Lombard House, 414 Veer Savarkar Marg,
VeerSavarkar Alternate No.:
No: +919223622666
+919223622566 (chargeable)
+919223622666 (chargeablel
Vinayak Temple,
Temple, Prabhadevi, Email: customersupport@icicilombard.com
New Linking Road, Malad (West), Near Siddhi Vinayak Prabhadevr, Email:
22 // 33
Mumbai - 400 064. Mumbai - 400 025. Website: www.icicilombard.com