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201509050364

Mr Narendra Ashokkumar Vaishnav This Policy Kit Contains:

A1/2, Panchtirth Society 1. The Policy Schedule along with income tax (80D)
Near Vasantvihar, Kathvada Road certificate (wherever applicable)
Naya Naroda 2. Member cashless card/s
Ahmedabad
Gujarat - 380030
India
Contact No.: 9909004824
Policy No.: 190100/11001/1000107053-05

Renewal of Your Easy Health Insurance Policy

Dear Mr Narendra Ashokkumar Vaishnav,

Thank You for renewing the policy with us.

We are pleased to enclose your renewed Policy Kit for the period 03-Sep-2015 to 02-Sep-2016

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,
Location : Gurgaon
Date : 05-Sep-2015
Authorized Signatory

Note:-
- Please visit our website www.apollomunichinsurance.com to access information about our company, the customer service touch
points including the Grievance handling process and various forms that you can use for service support. You will also get latest updates
on products, policy wordings which you can download for your reference and record.

- 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. 1800-102-0333.

Intermediary Code Intermediary Name Intermediary Contact No

80098120 NIRENKUMAR PATEL 9909004824

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 SCHEDULE - Easy Health Individual Standard

Issuing Office : Ahmedabad BO

Policy Holder's Name : Mr Narendra Ashokkumar Vaishnav
Policy Holder's Address : A1/2, Panchtirth Society
Near Vasantvihar, Kathvada Road
Naya Naroda
Ahmedabad
Gujarat - 380030
India
Intermediary Code : 80098120
Intermediary Name : NIRENKUMAR PATEL
Intermediary Contact No : 9909004824

Policy Number : 190100/11001/1000107053-05

First Policy inception date : 30-Aug-2010
Policy Period : From 16:03 hrs on 03-Sep-2015 To 24:00 hrs on 02-Sep-2016

Insured Persons Details :

Relationship to Sum Critical Illness Gross Premium Cumulative
Member ID Insured Person's Name Age
Policyholder Insured (Rs) Sum Insured (Rs) Bonus*
10001099696 Mr Narendra Ashokkumar Vaishnav 45 Policy Holder 400000 0 6424.66 157500
10001099700 Mrs Archana Narendra Vaishanav 44 Wife 200000 0 3730.45 43750
10001099701 Baby Kalash Narendra Vaishnav 16 Daughter 200000 0 2759.24 33750

*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 : Mrs Archana Relationship to Policyholder : Wife

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.) 11960.90
Discounts (Rs.) 1196.09
Loadings (Rs.) 563.57
Service Tax (Rs.) 1585.97
Duties and cess as applicable (Rs.) 0.00
Gross Premium (Rs.) 12914.35
Gross Premium amount (in words) Rupees Twelve Thousand Nine Hundred Fourteen and
Paisa Thirty-Five 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 Person Name Details
10001099696 Mr Narendra Ashokkumar For Rs 100000 (Rupees One Lakh) Sum Insured - Sec 6A i) and Sec 6A ii)) of the
Vaishnav policy wording is waived and Sec 6A iii) is reduced to 1 year.
For Rs 100000 (Rupees One Lakh) Sum Insured - Sec 6A i), Sec 6A ii)) and Sec 6A
iii)) of the policy wording is waived.
For Rs 125000 (Rupees One Lakh Twenty-Five Thousand) Sum Insured - Sec 6A i),
Sec 6A ii)) and Sec 6A iii)) of the policy wording is waived.
For Rs 75000 (Rupees Seventy-Five Thousand) Sum Insured - Sec 6A i), Sec 6A
ii)) and Sec 6A iii)) of the policy wording is waived.
10001099700 Mrs Archana Narendra For Rs 100000 (Rupees One Lakh) Sum Insured - Sec 6A i), Sec 6A ii)) and Sec 6A
Vaishanav iii)) of the policy wording is waived.
For Rs 25000 (Rupees Twenty-Five Thousand) Sum Insured - Sec 6A i), Sec 6A ii))
and Sec 6A iii)) of the policy wording is waived.
For Rs 75000 (Rupees Seventy-Five Thousand) Sum Insured - Sec 6A i), Sec 6A
ii)) and Sec 6A iii)) of the policy wording is waived.

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10001099701 Baby Kalash Narendra For Rs 100000 (Rupees One Lakh) Sum Insured - Sec 6A i) and Sec 6A ii)) of the
Vaishnav policy wording is waived and Sec 6A iii) is reduced to 1 year.
For Rs 25000 (Rupees Twenty-Five Thousand) Sum Insured - Sec 6A i), Sec 6A ii))
and Sec 6A iii)) of the policy wording is waived.
For Rs 75000 (Rupees Seventy-Five Thousand) Sum Insured - Sec 6A i), Sec 6A
ii)) and Sec 6A iii)) of the policy wording is waived.

LOADING
Member ID Person Name Loading Reason
10001099696 Mr Narendra Ashokkumar This policy is being charged 10% extra premium for Build.
Vaishnav

Claim Administrator : Apollo Munich For and on behalf of Apollo Munich Health Insurance Company Limited

Location : Gurgaon
Date : 05-Sep-2015 Authorized Signatory

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 Certificate for the purpose of deduction under Section 80 D of Income Tax Act, 1961*

This is to certify that the Proposer has paid 12914.34 (Rupees Twelve Thousand Nine Hundred Fourteen and Paisa Thirty-Four Only) towards
premium for Easy Health Individual Standard Policy No. 190100/11001/1000107053-05 issued to NARENDRA VAISHNAV for period
03-Sep-2015 to 02-Sep-2016.

For and on behalf of Apollo Munich Health Insurance Company Limited

Location:Gurgaon Authorized Signatory

Date :05-Sep-2015

* Note

1. This is subject to the provisions of Section 80D of Income Tax Act, 1961 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.
3. Please note that this certificate will not be issued if the premium payment has been made in cash.
4. In case of dishonour of the premium instrument, the policy will be deemed cancelled ab initio.
5. 80 D benefit is applicable for only Self, Spouse, Dependent Children and Dependent parents.

Page 4 of 4
 Mr Narendra Ashokkumar Vaishnav
DOB : 08-Dec-1969 - Male
Validity Period : 03-Sep-2015 to 02-Sep-2016
ID : 10001099696, Policy : 190100/11001/1000107053-05
 Mrs Archana Narendra Vaishanav
DOB : 11-Aug-1971 - Female
Validity Period : 03-Sep-2015 to 02-Sep-2016
ID : 10001099700, Policy : 190100/11001/1000107053-05
 Baby Kalash Narendra Vaishnav
DOB : 06-Dec-1998 - Female
Validity Period : 03-Sep-2015 to 02-Sep-2016
ID : 10001099701, Policy : 190100/11001/1000107053-05