Group MediCare Policy
Bharati Pathak
HOUSE NO -17 NAMGHAR PATH 2 GUWAHATI DISPUR RUKMINI NAGAR
NA
KAMRUP
KAMRUP 781006
ASSAM
6877/7212
j'_2e@d63-k
0238940249_02005350
24X7 Toll Free No: 1800 266 7780 or 1800 229966 (For Senior Citizens) Fax: 022 6693 8170 Email: [email protected]
Website: www.tataaig.com IRDA of India Registration No: 108 CIN:U85110MH2000PLC128425
TAGIC/RN/GMC/Jun 20/20 Ver 1/Axis 2060
Group MediCare Policy Renewal Slip
Other details: Insured’s PAN Card Number:
Identification card: Type _____________________________ Number: Please provide documentary address proof.
Please draw your cheque / DD in favour of Tata AIG General Insurance Company Limited. For any assistance call us on 24x7 Toll Free Helpline 1800 266 7780 See reverse to verify and correct
your policy details.
Commencement of risk cover under the policy is subject to receipt of premium by Tata AIG General Insurance Company Limited.
Prohibition of Rebates - Section 41 of the insurance Act, 1938 as amended by Insurance Laws (Amendment) Act, 2015
1. No person shall allow or offer to allow either directly or indirectly as an inducement to any person to take out or renew or continue an insurance in respect of any kind of risk relating to lives
or property in India, any rebate of the whole or part of the commission payable or any rebate of premium shown on the policy, nor shall any person taking out or renewing or continuing a
policy accept any rebate, except such rebate as may be allowed in accordance with the published prospectus or tables of the insurer.
TAGIC/RN/GMC/Jun 20/20
2. Any person making default in complying with the provisions of this section shall be liable for penalty which may extend to ten lakh rupees.
Declaration
I/We hereby declare and warrant that all of the statements/details mentioned above and overleaf are true and complete. If it is found that any particulars stated above are incorrect or untrue
in any respect. I/We hereby acknowledge that Insurance Company shall incur no liability for any insurance coverage.
I/we hereby confirm that all premiums have been/will be paid from bonafide sources and no premiums have been/will be paid out of proceeds of crime related to any of the offence listed in
Prevention of Money Laundering Act, 2002. 2.1 understand that the Company has the right to call for documents to establish sources of funds. 3. The insurance company has right to cancel
Ver 1/Axis 2060
the insurance contract in case I am/have been found guilty by any competent court of law under any of the statutes, directly or indirectly governing the prevention of money laundering in India.
Purchase of Tata AIG General Insurance Company Limited products are purely on voluntary basis. Insurance is the subject matter of solicitation.
For more details on risk factors, terms and conditions please read sales brochure carefully before concluding a sale.
24X7 Toll Free No: 1800 266 7780 or 1800 229966 (For Senior Citizens) Fax: 022 6693 8170 Email: [email protected]
Website: www.tataaig.com IRDA of India Registration No: 108 CIN:U85110MH2000PLC128425
Renew Your Tata AIG Group Health Insurance Today & Stay Protected
Group MediCare Easy Renewals Made Even Easier Now
Bharati Pathak 9706XXXXXX
[email protected] HOUSE NO -17 NAMGHAR PATH 2 GUWAHATI DISPUR RUKMINI NAGAR
NA
KAMRUP
KAMRUP 781006
ASSAM
Customer ID: 6155206226
Master Policy No./Certificate No.: 0238940249/02005350
Expiry date: 24/01/2025
Renewal Amount (Inc. GST): 1999
Dear Insured,
Greetings from Tata AIG General Insurance Company Limited. Thank you for choosing us as your preferred Health Insurance partner. Your Group MediCare
25/01/2025 Please renew your policy before the expiry date to continue enjoying you existing benefits. We look forward to a
Policy is due for renewal on dd/mm/yyyy.
long and healthy relationship with you and your family.
Trusted Naam, Fantastic Kaam!
Transparent Claim Settlement Comprehensive coverage 7200+ Cashless Hospitals
Your Policy Details
Master Policy No.: 0238940249 Net Renewal Premium: 1694
Certificate No.: 02005350 GST @18%: 305
Renewal Date: 25/01/2025 Total Premium Due: 1999
Insured Member Details
Name of the Insured Member Date of Birth Relationship with Policy Holder Sum Insured (Rs.)
Bharati Pathak 31/08/1979 Self
1500000
UJJAL DAS 11/08/1979 Spouse
REMARKS: Renewal premium might increase subject to age band change at the time of renewal
For TATA AIG General Insurance Co Ltd.
DS TATA AIG Digitally signed by DS
Digitally signed by Shammi Kapoor
GENERAL TATA AIG GENERAL Tata AIG General Insurance Co Ltd
INSURANCE CO LTD INSURANCE CO LTD 01
01 Date: 2024.10.22 15:46:51 Date: 22-10-2024 Location: Mumbai
Authorised Signature
Medical Exclusions:
• Expenses related to any admission primarily for diagnostics and evaluation purposes only
• Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof
• Expenses related to any unproven treatment, services and supplies for or in connection with any treatment. Unproven treatments are treatments, procedures or supplies that lack
significant medical documentation to
support their effectiveness
Non-Medical Exclusions:
• Any Insured Person committing or attempting to commit a breach of law with criminal intent
• Intentional self-injury or attempted suicide while sane or insane.
• Treatment rendered by a Medical Practitioner which is outside his discipline
Please refer to policy wordings for complete list of Benefits andExclusions.
Prohibition of Rebates - Section 41 of the Insurance Act, 1938
1. No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to renew an insurance in respect of any kind of risk relating to lives or property
in India, any rebate of the whole or part
of the commission payable or any rebate of the premium shown on the policy, nor shall any person taking out or renewing a policy accept any rebate, except such rebate as may
be allowed in accordance with the
published prospectuses or tables of the insurer:
2. Any person making default in complying with the provisions of this section shall be liable for penalty which may extend to ten lakh rupees.
Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms and conditions, please refer sales brochure / policy wordings carefully,
before concluding a sale.
Tata AIG General Insurance Company Limited
Registered Office: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel, Mumbai - 400 013, Maharashtra, India. IRDA of India Registration No: 108 | CIN No.:
U85110MH2000PLC128425 | PAN: AABCT3518Q | GST
No: 27AABCT3518Q1ZW | Group MediCare UIN: TATHLGP21248V022021
