V-Po Hiran,,Ludhiana - 141001, Ludhiana,Punjab,IndiaContact No.: 9872787996Policy No: 110600/11121/AA00302543-03

Mr Harinder Singh

Note:- - Please visit our website www.apollomunichinsurance.com to access information about our company, the customer service touch points including the Grievance handling process and various forms that you can use for service support. You will also get latest updates on products, policy wordings which you can download for your reference and record. - Please update us with your latest contact details (in case of any change) so that same can be updated in our records. You can either write back to us or call us on our toll free no. 1800-102-0333. - Coverage is not available for the period for which no premium is received. * Cashless Card as enclosed would be issued only once along with this policy kit and shall remain valid for further renewa

Renewal of Your Optima Restore Floater Insurance PolicyDear Mr Harinder Singh,

Thank You for renewing the policy with us.

We are pleased to enclose your renewed Policy Kit for the period 05-Oct-2018 to 04-Oct-2019.

To know more about policy related information and value added offers, you may re-register yourself at our website using your unique member ID and policy number as mentioned in the policy schedule.

In case of any query, please feel free to write to customerservice@apollomunichinsurance.com or call us at our 24 hours toll free number 1800-102-0333. Our customer care team will be happy to assist you.

Authorized Signatory

Warm Regards,

Intermediary Code Intermediary Contact No Intermediary Name

JASVIR SINGH80107371 9888390609

This Policy Kit contains:1. The Policy Schedule along with income tax (80 D) certificate (wherever applicable)2. Cashless card*

Location: GurgaonDate: 03-Oct-2018

Address

Name

Code 80107371

Mr Harinder Singh

Address V-Po Hiran,,Ludhiana - 141001, Ludhiana,Punjab,India

Policy Number

First policy inception date

Policy Period

Insured Persons Details

110600/11121/AA00302543-03

05-Oct-2015

24:00 hrs on 04-Oct-2019

Ludhiana Branch Office,2nd Floor, SCO - 146, Feroze Gandhi Market,Ludhiana,Punjab-141001,PH : 01614681933

Premium Calculation(in INR)

Net Premium

Loadings

Taxable Premium

Gross Premium

Gross premium amount (in words)

0.00

Rupees Sixteen Thousand Four Hundred Forty-Two and Paisa Twelve Only

16442.12

13934.00

Any other Cess or Taxes 0.00

Name

Contact No

JASVIR SINGH

Discounts 0.00

Member ID Insured Person's Name Date of Birth(Age)

Relationshipto

Policyholder

Basic SumInsured

(Rs.)

MultiplierBenefit

(Rs)

Mr Harinder Singh

Mrs Ravneet Kaur

Master Yuvraj Singh

Baby Prince Mashall

19-07-1985 (33)

11-07-1989 (29)

13-11-2013 (4)

14-06-2016 (2)

Policy Holder

Wife

Son

Son

300000500000

9888390609

CriticalAdvantage

Sum Insured(USD$)

0

0

0

0

CriticalAdvantage

Rider Premium(Rs)

GrossPremium

(Rs)

The nominee must be an immediate relative of the policyholder. For all other Insured Persons the policy holder shall be the nominee.

GSTIN 03AAGCA1654H1Z2

1254.06

1254.06

0.00

Place of Supply

Policy issuance date

State Name & Code

GSTIN/ UIN

Punjab(03) Ludhiana (Punjab)

03-Oct-2018

Issuing/Servicing Office Details

Policy Details

00:01 hrs on 05-Oct-2018From To

Intermediary Details

Policy Holder Details

The stamp duty of Rs. 1.00/- (Rupees One Only) paid vide e-stamp Certificate No. IN-DL-DL42844961502751O. (Not applicable for the state of Jammu & Kashmir)

10009236226

10009236254

10009236267

10010621186

0

0

0

0

Name Relationship Mrs Ravneet Kaur Wife

Nominee Details

Original for Recipient/ Duplicate for Supplier

Whether tax is payable on reverse charge basis: No

CGST@9%

SGST/UTGST@9%

IGST@0%

16442.12

Description/ Harmonized System Of Nomenclature Code: Accident and Health insurance Services/9971

13934.00

Policy Schedule - Optima Restore Floater

10009236226

10009236254

10009236267

10010621186

Mr Harinder Singh

Mrs Ravneet Kaur

Master Yuvraj Singh

Baby Prince Mashall

For Rs 300000 (Rupees Three Lakh) Sum Insured - Sec 5 A (i), Sec 5 A (ii) and Sec 5 A (iii) of the policy wording is waived.For Rs 300000 (Rupees Three Lakh) Sum Insured - Sec 5 A (i), Sec 5 A (ii) and Sec 5 A (iii) of the policy wording is waived.For Rs 300000 (Rupees Three Lakh) Sum Insured - Sec 5 A (i), Sec 5 A (ii) and Sec 5 A (iii) of the policy wording is waived.For Rs 300000 (Rupees Three Lakh) Sum Insured - Sec 5 A (i) and Sec 5 A (ii) of the policy wording is waived and Sec 5 A (iii) is reduced to 1 year.

EXCLUSION(S) / SPECIAL CONDITION(S)

Member ID No of Insured Person Name Details

For and on behalf of Apollo Munich Health Insurance Company Limited

Authorized SignatoryDate: 03-Oct-2018

Claim Administrator: Apollo Munich

Claim Administrator: Apollo Munich(For critical advantage rider:)

Location: Gurgaon

Certificate for the purpose of deduction under Section 80 D of Income Tax Act, 1961*

This is to certify that Harinder Singh has paid Rs 16442.12 (Rupees Sixteen Thousand Four Hundred Forty-Two and Paisa Twelve Only ) towards premium for Optima Restore Floater Policy No 110600/11121/AA00302543-03 issued to Mr Harinder Singh for period 05-Oct-2018 to 04-Oct-2019.

For and on behalf of Apollo Munich Health Insurance Company Limited

Authorized Signatory

Location: GurgaonDate: 03-Oct-2018

*Note

1. This is subject to the provisions of Section 80D of Income Tax Act, 1961 as amended from time to time.2. This certificate must be surrendered to the company in case of cancellation of this policy. In event of incorrect representation of this declaration the liability shall be upon the policy holder.3. Please note that this certificate will not be issued if the premium payment has been made in cash.4. In case of dishonour of the premium instrument, the policy will be deemed cancelled ab initio.5. 80D benefit is applicable for only Self, Spouse, Dependent Children and Dependent parents