CHOLAMANDALAM MS GENERAL INSURANCE COMPANY Ltd.
Registered Office: 2nd Floor, "Dare House", 2,N.S.C ,Bose Road, Chennai-600 001
Toll Free: 1800 208 9100, Phone: 044-40445400, Fax: 044-40445550
E. customercare@cholams.murugappa.com , Website. www.cholainsurance.com
PAN AABCC6633K GSTIN:33AABCC6633K1ZQ CIN U66030TN2001PLC047977
IRDA Regn. No.123
Chola Credit Link Group Hospital Cash Insurance
CHOHLGP21430V022021
Policy Certificate
Policy Details :
Business Location : JAIPUR - BRANCH Period of Insurance
Master Policy Number : 2883/00008453/000/00
From : 11/10/2024 hrs on 11:10:00
Master Policy Holder : AU SMALL FINANCE BANK LIMITED
To : Midnight of 10/10/2025
Loan Account No : L9001030143363107
Policy Certificate Number : 2883/00008453/5763/000/00
Name of the Insured : Rahevar Jitendrasinh
Address : 385 mahdev valo madh Gandhina garLimbodara MANSA
City : MANSA
State : GUJARAT
pincode : 382721
Mobile Number : 7878231036 Landline Number :
e-Mail ID : -
Maximum no. of days per policy year 60
Plan Name- AUF_HDC_1_1.5
Name of the Insured Age Date of Birth Gender(M/F) Relationship *Nominee Name Nominee Relation
Rahevar Jitendrasinh 32 01/11/1991 M Self Kinajalben Rahevar Spouse
* As per the nomination details provided by the Insured in the proposal form
Basic Covers -Daily Cash Benefit Per Day Optional Covers - Sum Insured (in Rs.)
Name of Daily Benefit for Daily Benefit for
the Daily Benefit for Daily Benefit for ICU Accompaniment Accompaniment Child
Normal Normal Convalescence
Insured ICU Hospitalisation- Hospitalisation- Benefit for Parent Benefit for Children Birth
Hospitalisation- Hospitalisation- Benefit
Sickness Accident Hospitalisation Hospitalisation Benefit
Sickness Accident
Rahevar
400 400 400 400 0 0 0 0
Jitendrasinh
PREMIUM
Net Premium Rs. 67/-
GST Rs. 12/-
Total Premium including GST 79/-
Premium in Words (Rupees Seventy-nine only)
INTERMEDIARY DETAILS
Intermediary Type : A U S F B J A I P U R C O M M O N W H E E L S Intermediary Code : 200250738270
Contact no : 1800120130130
Tax Exemption Certificate
This is to certify that a sum of Rs.79/- ( (Rupees Seventy-nine only)) (Net Premium Rs.67/- and R s .12/-) has been paid by Mr/Mrs. Rahevar Jitendrasinh towards Health Insurance policy certificate
number 2883/00008453/5763/000/00 for the duration of 11:10:00 hrs on 11/10/2024 to 23:59:59 on 10/10/2025
This certificate is issued for the purpose of Income Tax Deduction under Section 80D of the Income Tax Act
Note: The Certificate of Insurance / Policy Schedule is an important document issued based on your declaration. We request you to verify the details and ensure that everything is in order. In case of any
discrepancies, please contact us within 15 days from the date of issuance of policy.
In WITNESS WHEREOF, this Certificate of Insurance has been signed on 17/10/2024
For CHOLAMANDALAM MS GENERAL INSURANCE COMPANY LIMITED
@CholaSign1
Place : Chennai
Date : 17/10/2024 Authorised Signatory
The Certificate of Insurance is forming part and parcel of the policy and is governed by the terms and conditions of the policy
Consolidated stamp duty paid to the Government of Tamil Nadu
