Mrs Kalpana Sarkar

College Para
P.O-Chanchal
732123
Malda
West Bengal
India
Contact No.: 9593309644
Policy No: 150100/11001/1000050898-06

26-Oct-2015
Agency Code

80081550

Agency Name

RETAIL DIRECT - KOLKATA

Agency Contact No

18001020333

Renewal of Your Easy Health Insurance Policy

Dear Mrs Kalpana Sarkar,
Thank You for renewing the policy with us.
We are pleased to enclose your renewed Policy Kit for the period 29-Oct-2015 to 28-Oct-2016. The Kit contains:
1. The Policy Schedule along with income tax (80 D) certificate (wherever applicable)
2. Member cashless card/s, and
3. Important Information related to Claim Procedure

To know more about policy related information and value added offers, you may re-register yourself at our website using
your unique member ID and policy number as mentioned in the policy schedule.
In case of any query, please feel free to write to customerservice@apollomunichinsurance.com or call us at our 24 hours
toll free number 1800-102-0333. Our customer care team will be happy to assist you.
Warm Regards,

Authorized Signatory
Note:- Revision in Policy wordings (if any) due to regulatory compliance or any other reason can be accessed through our
website www.apollomunichinsurance.com.
- Please update us with your latest contact details (in case of any change) so that same can be updated in our records .
You can either write back to us or call us on our toll free no. 18001020333.

Issuing Office:
Policy Holder's Name:

SCHEDULE - Easy Health Individual Standard

Kolkata Branch Office
Mrs Kalpana Sarkar

Policy Holder's Address:

College Para
P.O-Chanchal
732123
Malda
West Bengal
India
80081550
RETAIL DIRECT - KOLKATA
18001020333

Agency Code:
Agency Name:
Agency Contact No:
Policy Number:

150100/11001/1000050898-06

First policy inception date:

29-Oct-2009

Policy Period: From 00.00 hrs on 29-Oct-2015

To 24.00 hrs on 28-Oct-2016

Insured Persons Details:

Member ID

Insured Person's Name

10000676604 Mrs Kalpana Sarkar

Age
59

Relationship to
Policyholder
Policy Holder

Sum
Insured
200000

Critical Illness
Gross
Sum Insured Premium (Rs)
0.00
9896.70

Cumulative
Bonus (Rs)*
60000

*The cumulative bonus (CB) shown in the Policy Schedule is provisional. The CB calculated on the Expiry Date, shall only be
considered as final. However, in case of any change in provisional CB, the same shall be intimated to You by Us through a separate
endorsement.
Nominee Name: Mr Nihar Ranjan Das
Relationship: Husband
The nominee must be an immediate relative of the policyholder. For all other Insured Persons the policy holder shall be the
nominee.
Premium Calculation:
Net Premium
(Rs)
8681.32
Discounts
(Rs)
0.00
Loadings
(Rs)
0.00
Service Tax
(Rs)
1215.38
Duties and cess as applicable
(Rs)
0.00
Gross Premium
(Rs)
9896.70
Gross premium amount (in words)

Rupees Nine Thousand Eight Hundred Ninety-Six and Paisa

Seventy Only

The stamp duty of Rs. 0.50/- (Paisa Fifty Only) paid vide No.F.10(783)/COS(HQ)/Con.duty/08. (Not applicable for the state of
Jammu & Kashmir).
Service Tax Registration No.: AAGCA1654HST002
EXCLUSION(S) / SPECIAL CONDITION(S)
Member ID No of Insured
Person Name
10000676604
Mrs Kalpana Sarkar

Claim Administrator: Apollo Munich

Location: Gurgaon
Date: 26-Oct-2015

Details
For Rs 200000 (Rupees Two Lakh) Sum Insured Sec 6A i), Sec 6A ii)) and Sec 6A iii)) of the policy
wording is waived.
For and on behalf of Apollo Munich Health Insurance Company Limited

Authorized Signatory

Certificate for the purpose of deduction under Section 80 D of Income Tax (Amendment) Act, 1986*
This is to certify that SOMTIRTHA DAS has paid Rs 9896.70 (Rupees Nine Thousand Eight Hundred Ninety-Six and Paisa Seventy
Only ) towards premium for Easy Health Individual Standard Policy No 150100/11001/1000050898-06 issued to Mrs Kalpana
Sarkar for period 29-Oct-2015 to 28-Oct-2016.

For and on behalf of Apollo Munich Health Insurance Company Limited

Location: Gurgaon
Date: 26-Oct-2015

Authorized Signatory

* Note
1. This is subject to the provisions of Section 80D of income tax (Amendment) Act, 1986 as amended from time to time.
2. This certificate must be surrendered to the company in case of cancellation of this policy. In event of incorrect representation of
this declaration the liability shall be upon the policy holder.