THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)
THE NEW INDIA ASSURANCE CO. LTD.
REGISTERED & HEAD OFFICE:87,MAHATMA GANDHI ROAD,MUMBAI
400001
Customer ID : 1H2687895
NEW INDIA TOP-UP MEDICLAIM POLICY SCHEDULE
UIN:NIAHLIP21276V022021
Insureds Details Issuing Office Details
Insured Name : MR ABHINAV DARBARI Office Code : THE NEW INDIA ASSURANCE CO LTD.
22, MOTHERS HOUSE (311502)
Address : A-2/43, AZAD APRTMENTS, NEW DELHI Address : 22, MOTHER HOUSE, IIND FLOOR,
DIST. : DELHI, DELHI YUSUF SARAI COMMERCIAL
COMPLEX
NEW DELHI ,DELHI, 110016 ,110049
Phone No/Mobile No. : XXXXXX4450, XXXXXX4196 Phone No : 01126966916
E-mail Id :
[email protected], / Fax No : 26861599
: E-mail :
[email protected]PAN No : AIJPD8939Q S.Tax Regn. No : AAACN4165CST178
GSTIN/UIN : NA / NA GSTIN : 07AAACN4165C1ZT
: SAC : 997133 (Accident and health insurance
services)
Policy Details
Business Source Code
Policy Number : 31150234247800000005 Dev.Off : MR. S.S.GOSAIN (2D10673796)
level./Broker/Direct/Web
Aggregator/CPSC User
Period of Insurance : From:07/04/2024 12:00:01 AM Agent/Bancassurance/Spe : Mr. VISHESWAR DATT ANTHWAL
To:06/04/2025 11:59:59 PM cified Person (NIA2D10662820)
Previous Policy No. : 31150234237800000005 Phone No : 9891717920 / 9810380826
Client Type : Non-Corporate E-mail/Fax : [email protected],
[email protected],
[email protected] / /
Policy Type : Floater
Member Details
Sl. No. Name of Insured Date of Birth Sex Occupation Relation Date of inception of Pre-existing
Person Continuous Disease
Coverage
1 MR ABHINAV 28/11/1980 Male Professional / Adm Self 07/04/2016 NA
DARBARI inistrative / Mana
gerial
2 DR (MRS) RENU 05/05/1950 Female Professional / Adm Parents 07/04/2016 NA
DARBARI inistrative / Mana
gerial
Sum Insured 1500000
Threshhold 500000
Member Details Of Previous policies
Sl. Name of Insured Person Expiring Policy No. Sum Insured Date of Inception of Threshold Pre-existing
No. first policy Disease
1 MR ABHINAV DARBARI 31150234237800000005 1500000 07/04/2016 500000 NA
2 DR (MRS) RENU 31150234237800000005 1500000 07/04/2016 500000 NA
DARBARI
Signature Not
Verified
Digitally signed
by DHIRAJ
KUMAR
Date: 2024.03.31 Policy No. : 31150234247800000005Document generated by QR_RENEWAL at 31/03/2024 16:34:01 Hours.
16:34:03 IST
Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
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Page 1 of 4
THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)
Details Of TPA(Notice or communication to be given in respect of claims)
Name : HEALTH INSURANCE TPA OF INDIA Telephone : 18001023600
LIMITED
Address : MAJESTIC OMNIA BUILDING,2ND Fax : 01204765799
FLOOR,,A-110, SECTOR – 4, Email :
NOIDA,NOIDA Toll Free No. :
A-110, SECTOR – 4, NOIDA Mobile No. :
NOIDA
Name of Nominee : DR RENU DARBARI Relation : MOTHER
Premium Working Table
Sl. No. Name of Insured Total Basic Premium Staff Discount Net Premium
1 MR ABHINAV DARBARI 1750 0 1750
2 DR (MRS) RENU DARBARI 16080 0 16080
Gross Premium 17830
GST 3210
Net Premium Amount 21040
Net Premium Amt.(In words) RUPEES TWENTY-ONE
THOUSAND FORTY ONLY
*This Policy is subject to terms and conditions of NEW INDIA TOP-UP MEDICLAIM POLICY.
Premium and GST Details
Rate of Tax Amount in INR
Premium 17830
SGST 9 1605
CGST 9 1605
IGST 0 0
Previous Policy Details
Sl. No. Previous Policy Name of Insured From Date To Date Sum Insured Threshhold Pre-existing Claim Amount
No Diseases
1 311502342278 NA 07/04/2022 06/04/2023 1500000 500000 N 0
00000003
2 311502342278 NA 07/04/2022 06/04/2023 0 0 N 0
00000003
3 311502342378 NA 07/04/2023 06/04/2024 1500000 500000 N 0
00000005
4 311502342378 NA 07/04/2023 06/04/2024 0 0 N 0
00000005
IN WITNESS WHEREOF,the undersigned being duly authorized has hereunto set his/her hand
at ______________ this _______________ day of _______________ 20
Authorized Signatory For and on behalf of
The New India Assurance Company Limited
Policy No. : 31150234247800000005Document generated by QR_RENEWAL at 31/03/2024 16:34:01 Hours.
Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
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Page 2 of 4
THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)
Insurer Office Code : THE NEW INDIA ASSURANCE CO LTD. 22, MOTHERS HOUSE (311502)
Address : 22, MOTHER HOUSE, IIND FLOOR, YUSUF SARAI COMMERCIAL COMPLEX
,110049
Telephone : 01126966916
Fax : 26861599
NEW INDIA TOP-UP MEDICLAIM
PREMIUM CERTIFICATE FOR THE PURPOSE OF DEDUCTION UNDER SECTION 80 D OF INCOME TAX ( AMENDMENT ) ACT 1986
This is to certify that Mr./Mrs. MR ABHINAV DARBARI has paid ` RUPEES TWENTY-ONE THOUSAND FORTY ONLY (in words)
towards premium for NEW INDIA TOP-UP MEDICLAIM for the period 07/04/2024 12:00:01 AM to 06/04/2025 11:59:59 PM
Policy no. : 31150234247800000005
Receipt no. & date : 10000089230301067319
31/03/2024
Date of Issue: 31/03/2024
(Mrs. ANITA CHANDRA)
[BM]
Authorized Signatory For and on behalf of
The New India Assurance Company
Limited
(Note: This certificate must be surrendered to the Insurance Company for issuance of fresh certificate in case of cancellation
of the policy or any alteration in the Insurance affecting the premium)
Policy No. : 31150234247800000005Document generated by QR_RENEWAL at 31/03/2024 16:34:01 Hours.
Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
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Page 3 of 4
THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)
IMPORTANT
This policy is subject to the terms and conditions contained in the policy document (Clauses).
This policy is governed by Health Insurance Regulations 2016 issued by Insurance Regulatory
Development Authority of India on 12.07.2016.
This policy is also governed by IRDAI (Protection of Policyholders' Interest) Regulations, 2017.
This Schedule comes attached with the policy document (Clauses). If not attached, please ask for the
same.
Health Insurance Regulation 2016 and IRDAI (Protection of Policyholders' Interest) Regulations, 2017 are
available on the website of IRDAI.
Beware of spurious calls offering alluring benefits. Never share any policy details with unknown callers.
Call 1800-209-1415 for any enquiry or contact the nearest operating office of New India Assurance Co Ltd.
We hereby declare that though our aggregate turnover in any preceding financial year from
2017-18 onwards is more than the aggregate turnover notified under sub-rule (4) of rule 48,
we are not required to prepare an invoice in terms of the provisions of the said sub-rule.
Tax Invoice No : 31150223P0015032
IRDA Registration Number: 190
NIA PAN NUMBER: AAACN4165C
Policy No. : 31150234247800000005Document generated by QR_RENEWAL at 31/03/2024 16:34:01 Hours.
Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
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Page 4 of 4
