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 : Manisha BHAGWANDAS DALAL
Address : M NO 98 WARD NO 21 BUDHWARA BURHANPUR,BUDHWARA ROAD,BUDHWARA
Pincode : 450331 Telephone : 9673707838 Email : rinkybhagat82@[Link]
PAN No. : GSTIN No. :
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Channel : RINKY BHAGAT Mobile : 9827260705 Email : rinkybhagat82@[Link]
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Aadhar : PAN : xxxxxx732Q Code. : 321000 / 9000149645
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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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MANISHA BHAGWANDAS DALAL 22/08/1975 FEMALE MARRIED 2,00,000.00
1 14,523.00
50 Years
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BUSINESS SELF NO 50,000.00
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
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Rs. 13,797.00 Rs. 13,797.00 Rs. 2,484.00 Rs. 16,281.00
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Collection Number :3210008122300000285 dated 26/04/2024
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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: receivable@[Link]
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Prev Policy : NATIONAL INSURANCE COMPANY LIMITED (Pol No: 321020502310000010 Expiry Date:)29/04/2025
:15
Nominee Name : TUSHAR DALAL Relation : SON Age : 25 Years
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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 [Link] 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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National Insurance Company Limited
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NIC/UBPORTAL/9000149645 26/04/2024 06:52 PM
Visit us at [Link] for information on Products, Services and Grievance Redressal.
Customer Care Toll Free Number: 1800 345 0330 Email: [Link]@[Link]
