ICICt Lon icy Number : 41131IXOL/06168948/00/000 jealth Caro 3 the premium from] ssid Proposal, Dec thereto together with] re proposer named in the Schedule ceferred to herein Below, and th lany slatement, report or other document leading to the issu ofthis Policy and referred to therein having been acoapled ane agreed to by the Company and the Proposer s the basis of this contract do. by iis policy agree, In consideration of and subject to the du| roceipt of the subsequant premiums, 3s set out inthe schedule with all ls parts, and further, subject to the terms and conditons| contained in his policy, as Set out in the schedule wit all its parts, that in proof tothe satisfaction of the Company af the compensation raving become payable asset cutin Part | cf teschedue fo the te Poicy the Sum Insudapproprata Beef wl be pad byte ‘ampany, ICICI Lombard House, 414, Veer Savarkar Nara, Near Siddh Vinayak Temple, Prabhadev, Mumbai 400025, Part | Of Schedule Policy Issuing Office Policy Issued On |19-Ju+-2011 7 _ Policy No 141 1310L/0616e048/00/000 canine ots] cores INEW DELHI - 110058 Email Address sto@navnitisters.com serve [DELHI a rm ta nan lation | Anni im Ins r 7 aor (Rs.) (Rs) (Rs) (Rs.) = 5224.84] 522.48) 10.45) 5.22| ‘5763 | For GIGI LOMBARD GENERAL INSURANCE COMPANY LimiTeD [Service Tax Reg. No: GISIMUMBA! "i frseszo0% rr: _ erica” Tax Code Number ad enn cirgoscsroot ead: “—— ffstagory General surance Busnes oe enone Authorized Signatory important Nate + Ths Schedule and the alached poloy shall be read together as one conirack Or any word or expression to which a) pees Tearing has been attached in any part of this policy or ofthe schedule shall bear the same meaning wherever i may appear. A. iMPORTANT sInsurance beneli shall bacome valdable at the option of the Company, in the event of any untrue or Incorrect statement stepresentation, non description or non-disclosure of any material particular inthe Proposal Form/ personal statement, declaration an nected documents, or any material information has been withheld by beneficiary ar anyone acting on beneficiary's behalf to obi Jnsurance benef. Please note that any claims arising out of pre-existing liness/injury'symptoms i excluded from the Scope af this policy] subject to applicable terms and conditons. Refer to atlached Part Il and Ill of the schedule forthe terms and conditions. All dsputes a ubject tothe juriedietion of Mumbai High Court only. The slamp duty of Rs.1 (One Only) paid in cash or by demand draltor by pay order ide ReoaipVChallan na SO410 dated 16 May-2011 n the happening of a claim, please call mmeciately at 1800 2666 (Toll Free) or e-mail us at ihealtncare@iciclombard.com fou can also wits to us at ICICI Lombard GIC, ICICI Lombard Health Care, TGV Mansion, 6th Fioar, Plot No, 6-2-1012, Khairatabad, Fivderabad ~ 500004, Andhra Pradesh, TeIGI Lombard General ngurance Company Ua Corp Office: ICICI Lombard House, 414, Veer Savarkar Marg, Neat Siddh Vinayak Temple, Prabhadei, Mumbai 400026. Mailing Adsress: 4h For, Interface 11, Of Malad Link Road, Behind Gorogaon Sports Cub, Malad), Mumbai. 400068 “Toll Free 247 Call Conter No 1800 2565, €-mal.cusiomersuoporu@iiclombard