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HealthShield RAL

This document is a risk assumption letter from ICICI Lombard General Insurance Company Limited to Rajesh Dutta regarding a health insurance policy. It provides details of the insured such as name, address, policy period, insured amount, and premium details. It confirms that policy IB360HS1000175629 has been issued to Rajesh Dutta based on the application details provided. The policy is governed by the terms and conditions of ICICI Lombard Health Shield 360 Master Policy no. 4177i/MSTR/291415383/00/000 issued to ICICI Bank Limited.

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45 views1 page

HealthShield RAL

This document is a risk assumption letter from ICICI Lombard General Insurance Company Limited to Rajesh Dutta regarding a health insurance policy. It provides details of the insured such as name, address, policy period, insured amount, and premium details. It confirms that policy IB360HS1000175629 has been issued to Rajesh Dutta based on the application details provided. The policy is governed by the terms and conditions of ICICI Lombard Health Shield 360 Master Policy no. 4177i/MSTR/291415383/00/000 issued to ICICI Bank Limited.

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© © All Rights Reserved
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For Buy/ Renew/ Service/ Claim related queries Log on to wwww.icicilombard.

com or call 1800 2666

RISK ASSUMPTION LETTER


Dear Sir / Madam,
We thank you for placing your confidence with ICICI Lombard for your Health Insurance Needs.

Please find attached here with Alternate Policy IB360HS1000175629 which has been issued based on the details furnished by the
No.
applicant.

ICICI Lombard Health Shield 360 Master Policy no. 4177i/MSTR/291415383/00/000 has been issued to ICICI Bank Limited at
Mumbai, by ICICI Lombard General Insurance Company Limited, for covering its members as specified in the policy and is governed by, and is
subject to, the terms, conditions & exclusions therein contained or otherwise expressed in the said policy, but not exceeding the sum insured as
specified in the said policy.

Name of the Policy Holder RAJESH DUTTA Policy Tenure (in Years) 1

Address 5A DAKSHIN BEHALA ROAD,DUTTS FIELD,KOLKATA,INDIA,WEST BENGAL

City 24 PARAGANA ( SOUTH ) State WEST BENGAL Pincode 7 0 0 0 6 1

Period of Insurance From 13/07/2023 To 12/07/2024

Email ID [email protected]

Mobile No. 8 6 9 7 2 8 3 8 1 9

Insured Details
Age Relationship with Sum Pre-existing
Name of the insured (s) Date of Birth Gender
Y M policy holder Insured illness /injury
RAJESH DUTTA 1 3 1 1 1 9 8 5 37 8 Male Self NA
D D M M Y Y Y Y - - - - -
5000000
D D M M Y Y Y Y - - - - -
D D M M Y Y Y Y - - - - -

Premium Details
Basic Premium Total Tax Payable Total Premium
7425 1337 8762
Please go through the details as furnished in the format and the policy document and confirm that same are order. In case there is any discrepancies
/ varia ons, you are requested to write back to us immediately at [email protected] or contact at 24 hour helpline number 1800
2666 for necessary changes /rectifications.
In the absence of any communica on from you in this connec on within a period of 15 days of receipt of this le er, we would take it that the issued
policy is in order as per your proposal.
ICICI Lombard General Insurance Company Limited
MailingAddress: InterfaceBuildingNo.16,601-602,6thFloor,NewLinkRoad,Malad(West),Mumbai-400064
Registered Office Address: : ICICI Lombard House, 414, Veer Savarkar Marg, Near Siddhi Vinayak Temple, Prabhadevi, Mumbai 400 025
Visitusatwww.icicilombard.com•[email protected]•TollFreeNo.: 18002666 •ChargableNo.: +918655222666
Insurance is the subject matter of solicitation. IRDA Reg. No. 115. CIN: L67200MH2000PLC129408 UIN: ICIHLGP22083V022122.

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