Issuing Office Name & Address
KHANDWA DIVISION ,FIRST FLOOR, ZAID PLAZA, ABOVE DAINIK
BHASKAR OFFICE, 79, PADAVA, KHANDWA, INDORE, MADHYA
PRADESH, PIN : 450001
Tel: Fax: 0733 2243342, 2243344 (G)
GSTIN No: 23AAACN9967E1ZB
National Insurance Company Ltd.
Registered & Head Office: PREMISES NO.18-0374, PLOT NO. CBD-81, NEW TOWN, KOLKATA-700156
POLICY SCHEDULE
Policy No: 32120048248560000002 NATIONAL MEDICLAIM POLICY from 15:15 Hrs of 26/04/2024 to Midnight of 25/04/2025
Insured Details
Name : Surabhi Dalal
Address : D3, 1006 Rohan Abhilasha, Pune, Maharastra
Pincode : 412207 Telephone : 7745001866 Email : [email protected]
PAN No. : GSTIN No. :
5
02
Channel : RINKY BHAGAT Mobile : 9827260705 Email : [email protected]
4/2
Aadhar : PAN : xxxxxx732Q Code. : 321000 / 9000149645
2 5/0
Member Details
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Name D.O.B Gender Marital Status S.I. (Rs.) Premium
Sr No
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Occupation Age Relation Dependence C.B. (Rs.) (Rs.)
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SURABHI DALAL 08/07/1997 FEMALE MARRIED 2,00,000.00
1 26,523.00
BUSINESS 28 Years SELF NO 50,000.00
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Any pre-existing disease: As per previous expire policy
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Premium Details
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PREMIUM PANDEMIC DISCOUNT NET PREMIUM GST NET PAYABLE
6-A
Rs. 13,797.00 Rs. 26,523.00 Rs. 4,774.14 Rs. 31,297.14
2
Collection Number :3210008122300000285 dated 26/04/2024
on
TPA : MD INDIA HEALTH INSURANCE TPA PVT LTD - INDORE
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TPA Address: F 39, MIG COLONY, BEHIND CHRISTIAN EMINENT COLLEGE, NEAR LIG SQUARE INDORE
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TPA Mobile Number: 9300102253 TPA Email: [email protected]
:56
Prev Policy : NATIONAL INSURANCE COMPANY LIMITED (Pol No: 321020502310000010 Expiry Date: 19/04/2025)
:15
Nominee Name : TUSHAR DALAL Relation : Spouse Age : 30 Years
15
IN WITNESS WHEREOF, the undersigned being duly authorized hereunto set his/her hand at the office address mentioned above, this 26/04/2024. This
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schedule, the attached policy, the clauses, the endorsements and policy wordings as available in the website https://nationalinsurance.nic.co.in shall be
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read together as one contract and any word or expression to which the specific meaning has been attached in any part of this policy or of the schedule shall
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bear the same meaning wherever it may appear. It is warranted that IN CASE OF DISHONOUR OF THE PREMIUM CHEQUE, THIS DOCUMENT STANDS
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AUTOMATICALLY CANCELLED 'AB-INITIO'.
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NOTE : Warranted that in case of dishonour of the premium cheque, this document stands automatically cancelled 'AB-INITIO'.
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Policy stamp to be defaced at the respective policy servicing office.
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Authorised Signatory
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For & On behalf of
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NIC/UBPORTAL/9000149645 26/04/2024 06:52 PM
Visit us at https://nationalinsurance.nic.co.in for information on Products, Services and Grievance Redressal.
Customer Care Toll Free Number: 1800 345 0330 Email:
[email protected]
