HDFC ERGO General Insurance Company Limited 2825100190208900000
POLICY SCHEDULE
Policy No. 2825 1001 9020 8900 000
Health Suraksha Policy
SILVER PLAN
Proposer Name SIKANDAR RAJBHAR Premium Frequency Yearly
Correspondence H.NO. 1812,TALOJA, VILL TALOJA Permanent H.NO. 1812, TALOJA, VILL TALOJA
Address PANCHANAND,FZM/X111/2729
RABALEH.NO. NR HOTEL STAR PLANET Address PANCHANAND, NR HOTEL STAR PLANET
RAIGAD, PANVEL, MAHARASHTRA, 410208 RAIGAD, PANVEL, MAHARASHTRA, 410208
2820
Mobile 9594174839 Phone - E Mail Policy Type Family Floater
Period of Insurance From Date & Time 06/04/2025 18:00 hrs To Date & Time 05/04/2030 Midnight
Insured Person’s Details & Sum Insured
Insured's Name Relationship Date of Birth Member ID 1st Policy Portability Pre Existing
Inception Sum Insured (`) Disease
SIKANDAR RAJBHAR SELF 01/05/2002 06/04/2025
RAMSHKAL RAJBHAR FATHER 15/04/1975 06/04/2025
Sum Insured(`) 300,000.00 CB Amount(`) 0.00
In case of increase in the Sum Insured at renewal, waiting period will apply afresh in relation to the amount by which the Sum Insured has been enhanced.
Nominee Name RAMSHKAL RAJBHAR Relationship FATHER
The nominee must be an immediate relative of the Insured Person. For all other insured person(s), the Policyholder shall be the nominee.
Coverage Details
Coverage Details Coverage Details
In Patient Treatment Covered Pre-Hospitalization 60 Days
Post-Hospitalization 90 Days Day Care Procedures Covered
Regain Benefit
Enhanced Cumulative Bonus 10% of Sum Insured; Maximum 100% of basic Sum Insured
Organ Donor
100%
AYUSH:Ayurvedic/Unani/Homeopathy/Sidha
Domiciliary Treatment Covered Covered
Emergency Ambulance (Limit per hospitalization) Upto Rs. 2000 Covered
Health Checkup (Post 4 claims free year Per Family) Upto 1% Sum Insured,Maximum
Upto Rs 5000
ThePolicyWordingattachedherewithincludesallthestandardcoveragesofferedbytheCompanytoitscustomers.Yourentitlementforcoverage/benefitsshallberestrictedtothecoverage/benefitsasmentionedin
this Policy Schedule issued to you. Please read the Policy Wording in conjunction with the Policy Schedule. For any clarification, please call our toll free number.
Premium Details (`)
Basic Premium 8782.33
Enhanced Cumulative Bonus(Loading) 219.56
Regain Benefit(Loading) 439.12
Total Premium excluding Service Tax 9441.00
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Service Tax 15% (Including Swachh Bharat cess 0.50%, Krishi Kalyan cess 0.50% as applicable) 1416.00
Total Premium 10857.00
Payment Details
Cheque No./DD/Fund Transfer Date Bank Name
HI1704002068 06/04/2025 KOTAK MAHINDRA BANK
Special Conditions
Exclusions
Registered&CorporateOffice:1stFloor,165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai - 400020. Customer Service Address: 6th Floor, Leela Business Park, Andheri Kurla Road, Andheri
(E),Mumbai-400059.TollFree:1800-2-700-700(AccessiblefromIndiaonly)| Fax : 91 22 6638 3699 | care@hdfcergo.com | www.hdfcergo.com. CIN : U66010MH2002PLC134869. IRDAI Reg No.
125.
