Date : 10/12/2019

Policy Number : IHS/Q0095734/2C/12

MRS B.U SUGANYA

172 PONNAPPA NADAR STREET

NAGAL NAGAR
DINDIGUL-624003
TAMIL NADU
INDIA 624003

Phone Number: 9650139995,8056650233

Email ID: udhay61@yahoo.co.in

Dear MRS B.U SUGANYA,

We thank you for choosing Bharti AXA General Insurance Ltd.
Your SMART HEALTH PREMIUM policy No IHS/Q0095734/2C/12 is enclosed. The terms, conditions, guidelines and other relevant
details of your insurance coverage are available in the enclosed policy document.

Bharti AXA General Insurance is amongst the fastest growing multi-line general insurance companies in India. We are the first General
Insurance company in India to be both ISO 9001:2008 and ISO 27001:2005 certified in our first year of operations.

Our bouquet of products is designed to cover all your insurance needs: from Health insurance, Motor insurance, Personal Accident
Insurance, Home insurance to other insurances pertaining to your Business. To know more about our product range or to buy online, kindly
visit www.bharti-axagi.co.in.

In order to assist you and service you better, we provide

Tie-up with 2000+ garages & over 4300 Hospitals across India that offer cashless facility

24x7 claims assistance

A quick and hassle free Claims Settlement process.

Visit us at www.bharti-axagi.co.in to know more. We take pride in going the extra mile in our service and look forward to a lasting relationship.

Should you require any further assistance on your policy or would like to know more about our products, please do reach
BHARTI AXA GENERAL INS.CO.LTD. (2C000070)
at (Office) 1800-103-2292

Warm regards,

Authorized Signatory

Registered Office Address:

BHARTI AXA GENERAL INSURANCE COMPANY LTD
HOSTO CENTRE No.43, Millers Road, Vasanth Nagar,
Bangalore - 560046. INDIA. IRDA Regn. No.139
Tel:1800-103-2292 Fax:80 40260101
Insurance is the subject matter of solicitation.WL/08/13
BHARTI AXA GENERAL INSURANCE COMPANY LTD
HOSTO CENTRE No.43, Millers
Road, Vasanth Nagar,
Bangalore - 560046. INDIA. SMART HEALTH PREMIUM
IRDA Regn. No.139 RENEWALS
Tel:1800-103-2292 Fax:80 40260101 Original
Email: customer.service@bhartiaxa.com

POLICY INFORMATION Policy No. : IHS/Q0095734/2C/12

Source : 2C000070 BHARTI AXA GENERAL INS.CO.LTD.

Insured : B.U SUGANYA

Address : 172 PONNAPPA NADAR STREET
NAGAL NAGAR
DINDIGUL-624003
TAMIL NADU
INDIA 624003
Period Of Insurance : From 17/12/2019 To Midnight on 16/12/2020
Transaction No. : 00004
Billing Currency : INR

PREMIUM
Gross Premium (INR) : 2,846.90
GST : 512.44
Total Premium : 3,359.34

Plan Description and Sum Insured

003 PREMIUM 300000

Details Of Insured Person

Serial No : 1
Name of the Person : B.U SUGANYA
Date of Birth : 06/05/1989
Gender : Female
Relation of the Insured with Proposer : Member (Self)
Serial No : 2
Name of the Person : R.H TANISHKA
Date of Birth : 29/07/2015
Gender : Female
Relation of the Insured with Proposer : Child
BHARTI AXA GENERAL INS.CO.LTD

Authorized Signatory
Conditions:
Pre-existing disease / illness / injury / conditions - The benefits will not be available for
any condition (s) as defined in the policy, until 48 months of continuous coverage have
elapsed, Since inception of the first policy with the Company.

BHARTI AXA GENERAL INSURANCE COMPANY LTD Continuation page 1

HOSTO CENTRE No.43, Millers Road, Vasanth Nagar, Bangalore - 560046. INDIA. IRDA Regn. No.139
Tel: 1800-103-2292 Fax: 80 40260101 Email: customer.service@bhartiaxa.com
BHARTI AXA GENERAL INSURANCE COMPANY LTD
HOSTO CENTRE No.43, Millers
Road, Vasanth Nagar,
Bangalore - 560046. INDIA. SMART HEALTH PREMIUM
IRDA Regn. No.139 RENEWALS
Tel:1800-103-2292 Fax:80 40260101 Original
Email: customer.service@bhartiaxa.com

Policy No. : IHS/Q0095734/2C/12

PREVIOUS POLICY NO:J0004102

RB162CIHS033012

RB1722IHS020697

RB1822IHS034563

RB192CIHS009083

This policy schedule should be read along with the policy wordings.

Issued by - INB6879 on 10/12/2019 ( R )

BHARTI AXA GENERAL INSURANCE COMPANY LTD

HOSTO CENTRE No.43, Millers Road, Vasanth Nagar, Bangalore - 560046. INDIA. IRDA Regn. No.139
Tel: 1800-103-2292 Fax: 80 40260101 Email: customer.service@bhartiaxa.com
 Original
Premium Statement for the purpose of deduction under
Section 80D of Income Tax Act,1961

Date : 10 Dec 2019

Policy Number : IHS/Q0095734/2C/12
Client ID : 10246432
MRS B.U SUGANYA
172 PONNAPPA NADAR STREET
NAGAL NAGAR
DINDIGUL-624003
TAMIL NADU
INDIA 624003

Dear MRS B.U SUGANYA

This is to state we have received from MRS B.U SUGANYA a sum of INR 3,359.34 by cheque
towards premium paid to effect/ keep in effect an insurance on the health of

1 B.U SUGANYA
Relationship : Member (Self) Age : 28
2 R.H TANISHKA
Relationship : Child Age : 2
for the period From 17/12/2019 to midnight on 16/12/2020. The breakup of the premium paid is as under:

Scheme Name: SMART HEALTH PREMIUM

Policy No Premium (INR) GST (INR) Total (INR)

Q0095734 2,846.90 512.44 3,359.34

Please note:
1. The above mentioned scheme has been approved by the Insurance Regulatory and Development
Authority vide approval dated 15th Dec 2008.
2. The premium paid towards the above mentioned scheme is eligible for deduction under section 80D of
the Income-tax Act, 1961 provided that the sum is paid towards health care insurance of the individual
or his/her spouse/ dependant children/parents.
3. The deduction under Section 80D is allowable subject to a maximum limit of INR 15,000 per annum
where the health care insurance has been taken for the individual/ his spouse/ his dependent children.
There is an additional deduction allowable under Section 80D subject to a maximum amount of INR
25,000 per annum in case the individual has paid any sum towards the health care insurance of his/her
parents.

BHARTI AXA GENERAL INSURANCE COMPANY LTD

HOSTO CENTRE No.43, Millers Road, Vasanth Nagar, Bangalore - 560046. INDIA. IRDA Regn. No.139
Tel: 1800-103-2292 Fax: 80 40260101 Email: customer.service@bhartiaxa.com
 In case the premium is paid to effect or keep in effect an insurance on the health of a person who is a
senior citizen (age of 65 years or more at any time during the year). the maximum deduction allowable is
INR 30,000.
In respect of HUFs, the maximum amount of deduction allowable under Section 80D is INR 25,000.

For and on behalf of

Bharti AXA General Insurance Company Limited

Authorized Signatory

This document is digitally signed

Signer: DS BHARTI AXA GENERAL

INSURANCE COMPANY LIMITED 3
Date: 10/12/2019 Date: Tue, Dec 10, 2019 18:58:07 IST Issuing Office: B2C
Location: MUMBAI
BHARTI AXA GENERAL INSURANCE COMPANY LTD
HOSTO CENTRE No.43, Millers Road, Vasanth Nagar, Bangalore - 560046. INDIA. IRDA Regn. No.139
Tel: 1800-103-2292 Fax: 80 40260101 Email: customer.service@bhartiaxa.com
 TAX INVOICE U/S 31 of CGST Act, 2017

Supplier's Name : BHARTI AXA GENERAL INSURANCE COMPANY LTD

Supplier's address : HOSTO CENTRE No.43, Millers
Road, Vasanth Nagar,
Bangalore - 560046. INDIA.
IRDA Regn. No.139
Tel:1800-103-2292 Fax:80 40260101
Email: customer.service@bhartiaxa.com
GSTIN of Supplier : 29AADCB2008D1Z8

Sold To Invoice No. : GC01432484

Buyer Name : B.U SUGANYA Date : 10/12/2019
Buyer Address :
172 PONNAPPA NADAR STREET
NAGAL NAGAR
DINDIGUL-624003
TAMIL NADU
INDIA 624003

Contact Number : 9650139995 ,8056650233

Email Id : udhay61@yahoo.co.in
Location of Recipient (State) : 33 -Tamil Nadu Location of Supply (State) : 29 -Karnataka

GSTIN of the buyer/ Unique ID : UNREGISTERED

IGST CGST SGST

Gross
Sr. No. Description SAC Value Total Value
Rate Amount Rate Amount Rate Amount

Q0095734/00004
1 PAHA/003 997133 569.38 18.00 102.49 0.00 0.00 0.00 0.00 671.87

Q0095734/00004
2 PHSA/003 997133 2,277.52 18.00 409.95 0.00 0.00 0.00 0.00 2,687.47

Total Amount Due 3,359.34

Total Invoice Value (In figures) 3,359.34

Total Invoice Value (In words) Three Thousand Three Hundred Fifty Nine Rupees and Thirty Four Paisa

Remarks, if any

For Bharti Axa General Insurance Co. Ltd.

Authorized Signatory
Dear B.U SUGANYA

We thank you for choosing Bharti AXA General Insurance.

Your Smart Health policy number is Q0095734 with Policy Period 17/12/2019 to 16/12/2020

S.No Name Date of Birth Gender Member details

1 B.U SUGANYA 06/05/1989 Female Member (Self)

2 R.H TANISHKA 29/07/2015 Female Child

Contact the below TPA in case of a claim

TPA Name Address & Contact Details

Srinilaya – Cyber Spazio

Suite # 101,102,109 & 110, Ground Floor,
Road No. 2, Banjara Hills,
Hyderabad, 500 034.
Family Health Plan Insurance TPA Limited.
Toll-free No.: 1800-425-4092(available 24/7)
Contact No.: 040-23555353
Fax No.: 040-23541400
Email: info@fhpl.net
Website: www. fhpl.net

Please note the following

1. This soft copy e- card is valid for identification when printed and presented with a valid proof of identity at Network Hospitals.
2. This card is valid only for hospitalization in India.

For any difficulties in a claim, please contact:

(For any claim related issues)

Working hours: Monday to Friday, 9 a.m. - 6p.m.
Now that you've secured your health,
protect your car's health too.
Why choose Bharti AXA?

Customized Insurance as per your needs with a host of add-on covers

Cashless network of over 2300 garages

24x7 claims assistance

Easy claim settlement process- such as registering your claim via WhatsApp

Hassle free online policy purchase

Please visit www.bharti-axagi.co.in right now or call 1800-103-2292.