Premium Certificate (Self)

For the purpose of deduction under section 80D of Income Tax amendment act, 196
1 and any amendments made thereafter. To, Ravindra Pratap Gupta
Flat No A 202, Hari Heritage Apartments, Plot No 17a, 18, 19, 20, Sector 22, Kamoth
e, In Front Of Khandeshwar Station, Navi Mumbai, Maharashtra 410206.
This is to certify that the company has received the premium of Rs. 9090 for Health
insurance coverage
under the policy no 4128i/iHR/78887043/02/000 vide Cheque/credit card dated
Apr292015.
The Product is eligible for deduction u/s 80 D of the Income Tax,1961 and any amen
dments made there to. For ICICI Lombard General Insurance Company
Limited,IRDA Regn.No.115 Authorized Signatory Note: l
This certificate must be surrendered to the Insurance Company in case of Cancellati
on of the
policy. In the event of incorrect representation of this declaration, the liability shall b
e upon the policyholder.

Premium Certificate (Daughter & Wife)

For the purpose of deduction under section 80D of Income Tax amendment act, 196
1 and any amendments made thereafter. To, Ravindra Pratap Gupta
Flat No A 202, Hari Heritage Apartments, Plot No 17a, 18, 19, 20, Sector 22, Kamoth
e, In Front Of Khandeshwar Station, Navi Mumbai, Maharashtra 410206.
This is to certify that the company has received the premium of Rs. 10467 for Healt
h insurance coverage
under the policy no 4128i/iHR/78887022/02/000 vide Cheque/credit card dated
Apr292015.
The Product is eligible for deduction u/s 80 D of the Income Tax,1961 and any amen
dments made there to. For ICICI Lombard General Insurance Company
Limited,IRDA Regn.No.115 Authorized Signatory Note: l
This certificate must be surrendered to the Insurance Company in case of Cancellati
on of the
policy. In the event of incorrect representation of this declaration, the liability shall b
e upon the policyholder.