Digitally signed by Suraj Mishra

Date: 2016.02.07 11:07:27 +05:30

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201602060397

Mr Dushyant N Parekh This Policy Kit Contains:

22 Paraskunj Society Part-1 Nr 1. The Policy Schedule along with income tax (80D)
Umiya Vijay Society certificate (wherever applicable)
Satellite 2. Member cashless card/s
Ahmedabad, Ahmedabad
Gujarat - 380015
India
Contact No.: 9724169950
Policy No.: 190100/11051/1000361181-03

Renewal of Your Easy Health Insurance Policy

Dear Mr Dushyant N Parekh,

Thank You for renewing the policy with us.

We are pleased to enclose your renewed Policy Kit for the period 06-Feb-2016 to 05-Feb-2017

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.

Warm Regards,
Location : Gurgaon
Date : 06-Feb-2016
Authorized Signatory

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.

Intermediary Code Intermediary Name Intermediary Contact No

80098120 NIRENKUMAR PATEL 9909004824

Page 1 of 4
 SCHEDULE - Easy Health Floater Standard

Issuing / Servicing Office : Ahmedabad BO, 4th Floor, Radhika, OppMayor Bunglow, Near
Law Garden, Ellise Bridge, Gujarat - 380006
Policy Holder's Name : Mr Dushyant N Parekh
Policy Holder's Address : 22 Paraskunj Society Part-1 Nr
Umiya Vijay Society
Satellite
Ahmedabad, Ahmedabad
Gujarat - 380015
India
Intermediary Code : 80098120
Intermediary Name : NIRENKUMAR PATEL
Intermediary Contact No : 9909004824

Policy Number : 190100/11051/1000361181-03

First Policy inception date : 05-Feb-2013
Policy Period : From 00:00 hrs on 06-Feb-2016 To 24:00 hrs on 05-Feb-2017

Insured Persons Details :

Critical Critical
Relationship Critical Advantage Advantage Gross
Insured Person's Sum Cumulative
Member ID Age to Illness Sum Insured Rider Premium
Name Insured (Rs) Bonus*
Policyholder Sum Insured (USD$) Premium (Rs)
(Rs)
10005166796 Mr Dushyant N Parekh 40 Policy Holder 0 0 0
10005166802 Mrs Panna D Parekh 38 Wife 300000 0 0 0 8910.68 70000
10005166804 Master Henil D Parekh 11 Son 0 0 0

*The cumulative bonus (CB) shown in the Policy Schedule is provisional. The CB calculated on the Expiry Date, shall only be considered as
final. However, in case of any change in provisional CB, the same shall be intimated to You by Us through a separate endorsement.

Nominee Name : Relationship to Policyholder :

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 (Rs.) 7782.25
Discounts (Rs.) 0.00
Loadings (Rs.) 0.00
Service Tax (Rs.) 1089.52
Duties and cess as applicable (Rs.) 38.91
Gross Premium (Rs.) 8910.68
Gross Premium amount (in words) Rupees Eight Thousand Nine Hundred Ten and Paisa
Sixty-Eight Only

The stamp duty of Rs. 0.50 /- (Paisa Fifty Only) paid vide No.F.10(783)/COS(HQ)/Con.duty/08. (Not applicable for the state of Jammu & Kashmir).
Service Tax Registration No.: AAGCA1654HST002

EXCLUSION(S) / SPECIAL CONDITION(S)

Member ID Person Name Details
10005166796 Mr Dushyant N Parekh For Rs 100000 (Rupees One Lakh) Sum Insured - Sec 6A i) of the policy wording is
waived, Sec 6A ii) is reduced to 1 year and Sec 6A iii) is reduced to 2 years.
For Rs 200000 (Rupees Two Lakh) Sum Insured - Sec 6A i), Sec 6A ii)) and Sec 6A
iii)) of the policy wording is waived.
10005166802 Mrs Panna D Parekh For Rs 100000 (Rupees One Lakh) Sum Insured - Sec 6A i) of the policy wording is
waived, Sec 6A ii) is reduced to 1 year and Sec 6A iii) is reduced to 2 years.
For Rs 200000 (Rupees Two Lakh) Sum Insured - Sec 6A i), Sec 6A ii)) and Sec 6A
iii)) of the policy wording is waived.
10005166804 Master Henil D Parekh For Rs 100000 (Rupees One Lakh) Sum Insured - Sec 6A i) of the policy wording is
waived, Sec 6A ii) is reduced to 1 year and Sec 6A iii) is reduced to 2 years.
For Rs 200000 (Rupees Two Lakh) Sum Insured - Sec 6A i), Sec 6A ii)) and Sec 6A
iii)) of the policy wording is waived.

Page 2 of 4
Claim Administrator : Apollo Munich For and on behalf of Apollo Munich Health Insurance Company Limited

Claim Administrator : Not Applicable

(For critical advantage rider)

Location : Gurgaon
Date : 06-Feb-2016 Authorized Signatory

Page 3 of 4
 Certificate for the purpose of deduction under Section 80 D of Income Tax Act, 1961*

This is to certify that the Proposer has paid 8910.68 (Rupees Eight Thousand Nine Hundred Ten and Paisa Sixty-Eight Only) towards premium
for Easy Health Floater Standard Policy No. 190100/11051/1000361181-03 issued to Dushyant N Parekh for period 06-Feb-2016 to
05-Feb-2017.

For and on behalf of Apollo Munich Health Insurance Company Limited

Location:Gurgaon Authorized Signatory

Date :06-Feb-2016

* 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. 80 D benefit is applicable for only Self, Spouse, Dependent Children and Dependent parents.

Page 4 of 4
 Mr Dushyant N Parekh
DOB : 30-Apr-1975 - Male, CODE : 359
ID : 10005166796, Policy : 190100/11051/1000361181-03
Validity Period : 06-Feb-2016 to 05-Feb-2017
 Mrs Panna D Parekh
DOB : 31-Jul-1977 - Female, CODE : 359
ID : 10005166802, Policy : 190100/11051/1000361181-03
Validity Period : 06-Feb-2016 to 05-Feb-2017
 Master Henil D Parekh
DOB : 27-Apr-2004 - Male, CODE : 359
ID : 10005166804, Policy : 190100/11051/1000361181-03
Validity Period : 06-Feb-2016 to 05-Feb-2017