*123368532*

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory and Development Authority of India [IRDAI] vide Regd. No.113)
Regd. Office: Bajaj Allianz House, Airport Road, Yerwada, Pune 411006 (India)

Welcome to Bajaj Allianz Family

Policy issuing office and Correspondence address for communication Bajaj Finserv Building, 1st Floor, Behind Weikfield ITPark,
by policyholder for claim, service request, notice, summons, etc. Viman Nagar, Pune-411014 Phone No :1800-209-0144
Proposer Name RAJBIR SHARMA Policy Number OG-20-9906-8430-00002581

RAJBIR SHARMA
GALLI NO 11 ADARSH COLLONY PALWL
BEHIND SUKHARAM, HOSPITAL
FARIDABAD,

FARIDABAD, INDIA,
Pin - 121102
Customer ID : 155667591 *OG-20-9906-8430-00002581*

Dear Customer,

Thank you for choosing Bajaj Allianz General Insurer as your preferred insurer. Bajaj Allianz
General Insurance Company Limited, a consistently profitable insurer enjoys a reputation of
expertise, stability and strength. We are a customer focused market leader present in over 200
locations across India. As an organization we strive to understand the risk management needs of
our consumers and translate it into affordable products and services of global quality that deliver
value for money. Bajaj Allianz has an ISO Certified claims process and has received iAAA rating for
the last three consecutive years from ICRA Limited, an associate of Moody's Investors Service, for
claims paying ability. The rating indicates highest claims paying ability and a fundamentally strong
position in the industry.

We request you to kindly go through the contents of the policy schedule and the terms and
conditions. In case of any clarification or disagreement, please write to us at
Bagichelp@bajajallianz.co.in within fifteen days of receipt of this policy.

We assure you the best of our services and look forward to a continual patronage and association
with you.

For & on the behalf

Bajaj Allianz General Insurance Company Ltd.

Authorized Signatory

For help and more information: Page 1 of 11

Contact our 24 Hour Call Centre at 1800-209-5858, 1800-102-5858 (Toll Free)
Email: Bagichelp@bajajallianz.co.in , Website www.bajajallianz.com

Corporate Identification Number: U66010PN2000PLC015329 | Demystify Insurance http://support.bajajallianz.com

http://www.facebook.com/BajajAllianz http://twitter.com/BajajAllianz www.bit.do/bjazgi

 *123368532*

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory and Development Authority of India [IRDAI] vide Regd. No.113)
Regd. Office: Bajaj Allianz House, Airport Road, Yerwada, Pune 411006 (India)

HEALTH GUARD (FLOATER) TRANSCRIPT OF PROPOSAL UIN. IRDAI/HLT/BAGI/P-H/V.II/113/16-17

Policy issuing office and Correspondence address for communication Bajaj Finserv Building, 1st Floor, Behind Weikfield ITPark,
by policyholder for claim, service request, notice, summons, etc. Viman Nagar, Pune-411014 Phone No :1800-209-0144
Proposer Name RAJBIR SHARMA Policy Number OG-20-9906-8430-00002581

Dear RAJBIR SHARMA,

We wish to inform you that the your contract will be based on the information and declaration given by you through telephonic
conversation / email / web-inputs / TAB or other means which would be considered as the final proposal, the transcript of
which is as follows:

You are requested to yourself reconfirm the same at your end. In case of any disagreement or objection or any changes with
respect to information mentioned below, we request you to please revert back within a period of 15 days from the date of your
receipt of this document. In case of our non-receipt of your disagreement or objection or any changes [as mentioned
hereinabove] with respect to information mentioned below, it shall be deemed that you have positively confirmed to us the
correctness of the below mentioned transcript and declaration. Where you disagree to any of information/contents of this
transcript, standard Terms or conditions, you have the option to return the original Policy stating the reasons for your
objection, and upon our receipt of original Policy together with your request to cancel the Policy, shall be entitled to a refund of
the premium paid, subject only to there being no claim made under the Policy and also subject to a deduction of the expenses
incurred by us and the stamp duty charges.

Personal Information
First Name RAJBIR
Middle Name Last Name SHARMA
Email Address RAJBIRSHARMA260@GMAIL.COM Mobile Number 9541241260
Date of Birth 14-NOV-89 Nationality
Pan No NA Unique Identity
(Aadhaar No.)
Salary Occupation
Marital Status Family Monthly
Income
Permanent Address Mailing Address
House No/ GALLI NO 11 ADARSH COLLONY PALWL House No/ GALLI NO 11 ADARSH COLLONY PALWL
Building No/ Flat BEHIND SUKHARAMHOSPITAL FARIDABAD Building No/ Flat BEHIND SUKHARAMHOSPITAL FARIDABAD
No No
Street/ Locality/ Street/ Locality/
Landmark Landmark
State INDIA State INDIA
City FARIDABAD City FARIDABAD
Area FARIDABAD Area FARIDABAD
Pincode 121102 Pincode 121102

Q1.Has any of the persons to be insured suffer from/or investigated for any of the following?
Disorder of the heart, or circulatory system, chest pain, high blood pressure, stroke, asthma any respiratory conditions, cancer
tumor lump of any kind, diabetes, hepatitis, disorder of urinary tract or kidneys, blood disorder, any mental or psychiatric
conditions, any disease of brain or nervous system, fits (epilepsy) slipped disc, backache, any congenital/ birth defects/ urinary
diseases, AIDS or positive HIV, any accident or any other disease. If yes, indicate in the table given below.
Ans. No
Q2. Do you or any of the family members to be covered have/had any health complaints/met with any accident in the past 4yrs
or prior to 4yrs and have been taking treatment/ hospitalization? Please provide the details & duration of illness along with
treatment taken in below table
Ans. No

For help and more information: Page 2 of 11

Contact our 24 Hour Call Centre at 1800-209-5858, 1800-102-5858 (Toll Free)
Email: Bagichelp@bajajallianz.co.in , Website www.bajajallianz.com

Corporate Identification Number: U66010PN2000PLC015329 | Demystify Insurance http://support.bajajallianz.com

http://www.facebook.com/BajajAllianz http://twitter.com/BajajAllianz www.bit.do/bjazgi

 *123368532*

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory and Development Authority of India [IRDAI] vide Regd. No.113)
Regd. Office: Bajaj Allianz House, Airport Road, Yerwada, Pune 411006 (India)

HEALTH GUARD (FLOATER) TRANSCRIPT OF PROPOSAL UIN. IRDAI/HLT/BAGI/P-H/V.II/113/16-17

Policy issuing office and Correspondence address for communication Bajaj Finserv Building, 1st Floor, Behind Weikfield ITPark,
by policyholder for claim, service request, notice, summons, etc. Viman Nagar, Pune-411014 Phone No :1800-209-0144
Proposer Name RAJBIR SHARMA Policy Number OG-20-9906-8430-00002581

Insured/ Gender Date of Birth Relation Height Weight Cumulati Sum Nominee Name Nominee
Beneficiary Name with (in cm) (in kg) ve Bonus insured relation
Insured (Floater with
Basis) Beneficia
ry
rajbir sharma Male 14-NOV-1989 SELF NA NA 0.00(0%) 3,00,000 kunika mangla SPOUSE
Details if Q1 &/or 2 .00
is Answered as YES NA
kunika mangla Female 04-NOV-1993 SPOUSE NA NA kunika mangla SPOUSE
Details if Q1 &/or 2
is Answered as YES NA
gargi sharma Female 05-FEB-2019 DAUGHT NA NA kunika mangla SPOUSE
ER
Details if Q1 &/or 2
is Answered as YES NA

Kindly note that as the information/contents and declarations/confirmations provided by you as contained in this transcript is
the basis on which we have issued the Policy to you, we advise you to please ensure that you have provided/disclosed and or
not withheld any material facts/information and declarations, as Policy becomes Void ab-initio if material facts are not
provided/disclosed and or withheld and in such case no claim, if any, will be considered by us apart from forfeiture of the
premium.

A. Coverage Details:
1. Plan Name : Health Guard Family-Floater: Gold Plan
2. Premium Payment Zone :A
3. Period of Insurance : From: 22-JUL-2019 15:07 Hrs. To : 21-JUL-2020 Midnight
4. Is Voluntary Co-payment Opted : No
Amount of Voluntary Co-payment opted :0
5. Add On Cover Opted : No
6. Previous Insurance Provider : NA
7. Previous Policy number : NA
8. Previous Policy expiry Date : NA

For help and more information: Page 3 of 11

Contact our 24 Hour Call Centre at 1800-209-5858, 1800-102-5858 (Toll Free)
Email: Bagichelp@bajajallianz.co.in , Website www.bajajallianz.com

Corporate Identification Number: U66010PN2000PLC015329 | Demystify Insurance http://support.bajajallianz.com

http://www.facebook.com/BajajAllianz http://twitter.com/BajajAllianz www.bit.do/bjazgi

 *123368532*

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory and Development Authority of India [IRDAI] vide Regd. No.113)
Regd. Office: Bajaj Allianz House, Airport Road, Yerwada, Pune 411006 (India)

HEALTH GUARD (FLOATER) TRANSCRIPT OF PROPOSAL UIN. IRDAI/HLT/BAGI/P-H/V.II/113/16-17

Policy issuing office and Correspondence address for communication Bajaj Finserv Building, 1st Floor, Behind Weikfield ITPark,
by policyholder for claim, service request, notice, summons, etc. Viman Nagar, Pune-411014 Phone No :1800-209-0144
Proposer Name RAJBIR SHARMA Policy Number OG-20-9906-8430-00002581

B. EXCLUSIONS AND TERMS AND CONDITIONS:

The detailed list of exclusions, standard terms and conditions, including the exclusion of pre-existing ailments/diseases, were
fully explained to you and for full details thereof please refer to the Policy wordings:

Answer given by You: Yes, I/we have been explained in full the details of exclusions, standard terms and conditions including
the exclusion of pre-existing ailments/diseases and knowing the same I/we have opted and proposed for this Policy.

The contents of the proposal [transcript of proposal of you is this document] and connected documents have been fully
explained to him and you have fully understood the significance of the proposed contract basis which you have confirmed for
policy issuance.

In case of Disagreement or objection or any changes with respect to information, declarations, Terms and Conditions,
exclusions and contents mentioned hereinabove, please contact our toll free number & register your objections / changes /
disagreement to the contents of this transcript or you may also send us email or written correspondence at the following
details within a period of 15 days from date of your receipt of this transcript along with Policy.

DECLARATION:
1. I hereby declare, on my behalf and on behalf of all persons proposed to be insured, that the above statements, answers
and/or particulars given by me are true and complete in all respects to the best of my knowledge and that I am authorised to
propose on behalf of these other persons.

2. I understand that the information provided by me will form the basis of the insurance policy, is subject to the Board
approved underwriting policy of the insurerand that the policy will come into force only after full payment of the premium
chargeable..

3. I further declare that I will notify in writing any change occurring in the occupation or general health of the life to be
insured/proposer after the proposal has beensubmitted but before communication of the risk acceptance by the company.

4. I declare that I consent to the company seeking medical information from any doctor or hospital who/which at any time has
attended on the person to beinsured/proposer or from any past or present employer concerning anything which affects the
physical or mental health of the person to be insured/proposer andseeking information from any insurer to whom an
application for insurance on the person to be insured /proposer has been made for the purpose ofunderwriting the proposal
and/or claim settlement.

5. I authorize the company to share information pertaining to my proposal including the medical records of the
insured/proposer for the sole purpose of underwriting theproposal and/or claims settlement and with any Governmental
and/or Regulatory authority.

Toll free Number: 1800-103-2529, 1800-22-5858, 1800-102-5858 and 1800-209-5858

Email address: Bagichelp@bajajallianz.co.in
Website: www.bajajallianz.com

Contact our Policy servicing branch at:

Bajaj Finserv Building, 1st Floor, Behind Weikfield ITPark, Viman Nagar, Pune-411014 Phone No :1800-209-0144
This is print of electronic records maintained by us in accordance with law and hence does not require signature.
Scrutiny No:123368532

For help and more information: Page 4 of 11

Contact our 24 Hour Call Centre at 1800-209-5858, 1800-102-5858 (Toll Free)
Email: Bagichelp@bajajallianz.co.in , Website www.bajajallianz.com

Corporate Identification Number: U66010PN2000PLC015329 | Demystify Insurance http://support.bajajallianz.com

http://www.facebook.com/BajajAllianz http://twitter.com/BajajAllianz www.bit.do/bjazgi

 *123368532*

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory and Development Authority of India [IRDAI] vide Regd. No.113)
Regd. Office: Bajaj Allianz House, Airport Road, Yerwada, Pune 411006 (India)

HEALTH GUARD (FLOATER) TRANSCRIPT OF PROPOSAL UIN. IRDAI/HLT/BAGI/P-H/V.II/113/16-17

Policy issuing office and Correspondence address for communication Bajaj Finserv Building, 1st Floor, Behind Weikfield ITPark,
by policyholder for claim, service request, notice, summons, etc. Viman Nagar, Pune-411014 Phone No :1800-209-0144
Proposer Name RAJBIR SHARMA Policy Number OG-20-9906-8430-00002581

INSURANCE ACT, 1938 SECTION 41 - PROHIBITION OF REBATES

No person shall allow or offer to allow either directly or indirectly, as an inducement to any person to take out or renew or
continue an insurance in respect of any kind of risk relating to lives or property in India, any rebate of the whole or part of the
commission payable or any rebate of the premium shown on the policy, nor shall any person taking out or renewing a policy
accept any rebate, except such rebate as may be allowed in accordance with the published prospectus or tables of the insurer.
ANY PERSON IN BREACH OF COMPLYING WITH THE PROVISIONS OF THIS SECTION SHALL BE PUNISHABLE WITH FINE WHICH
MAY EXTEND TO RUPEES TEN LAKH.Bajaj Allianz General Insurance Co Ltd

Authorized signatory

For help and more information: Page 5 of 11

Contact our 24 Hour Call Centre at 1800-209-5858, 1800-102-5858 (Toll Free)
Email: Bagichelp@bajajallianz.co.in , Website www.bajajallianz.com

Corporate Identification Number: U66010PN2000PLC015329 | Demystify Insurance http://support.bajajallianz.com

http://www.facebook.com/BajajAllianz http://twitter.com/BajajAllianz www.bit.do/bjazgi

 *123368532*

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory and Development Authority of India [IRDAI] vide Regd. No.113)
Regd. Office: Bajaj Allianz House, Airport Road, Yerwada, Pune 411006 (India)

HEALTH GUARD (FLOATER) POLICY SCHEDULE UIN. IRDAI/HLT/BAGI/P-H/V.II/113/16-17

Policy issuing office and Correspondence address for communication Bajaj Finserv Building, 1st Floor, Behind Weikfield ITPark,
by policyholder for claim, service request, notice, summons, etc. Viman Nagar, Pune-411014 Phone No :1800-209-0144
Proposer Name RAJBIR SHARMA Policy Number OG-20-9906-8430-00002581

PROPOSER DETAILS POLICY DETAILS

GALLI NO 11 ADARSH COLLONY PALWL Policy Issued on 22-JUL-2019
BEHIND SUKHARAM, HOSPITAL Period of From: 22-JUL-2019 15:07 Hrs.
FARIDABAD, Insurance
Proposer Address To : 21-JUL-2020 Midnight
FARIDABAD, INDIA, Customer ID 155667591
Pin - 121102 Policy Status Issued
Previous Policy No. - Expiry Date -
Insured Member Details
Member Name Customer ID Gender Date Of Birth Age Relation Nominee Name & Relation
rajbir sharma 155667591 Male 14-NOV-1989 29 SELF kunika mangla SPOUSE
kunika mangla 155667592 Female 04-NOV-1993 25 SPOUSE kunika mangla SPOUSE
DAUGHT
gargi sharma 155667593 Female 05-FEB-2019 0 kunika mangla SPOUSE
ER
GSTIN / UIN STATE CODE /NAME
NA 06 - Haryana
Sum Insured & Cover Details
Daily Cash for Accompanying
Inpatient Hospitalization Treatment Convalescence Benefit Maternity Expenses
an Insured Child
Cumulative
Sum Insured Sum Insured Sum Insured Sum Insured
Bonus
3,00,000.00 0.00(0%) 5,000.00 0.00 25,000.00
Premium Details
Description Amount(INR) Description Amount(INR)
Base Premium 9,555.00 Less: Long Term Policy Discount 0.00
Less: Employee Discount 0.00
Premium Payment Zone A Less: Voluntary Co-payment Discount @ 10% / 20% 0.00
Voluntary Co-payment Opted- 10%/20% 0% Net Premium 9,555.00
Gross Premium: Rupees Eleven Thousand Two Hundred Integrated GST (18%) 1720
Seventy Five Only Gross Premium 11,275.00

For help and more information: Page 6 of 11

Contact our 24 Hour Call Centre at 1800-209-5858, 1800-102-5858 (Toll Free)
Email: Bagichelp@bajajallianz.co.in , Website www.bajajallianz.com

Corporate Identification Number: U66010PN2000PLC015329 | Demystify Insurance http://support.bajajallianz.com

http://www.facebook.com/BajajAllianz http://twitter.com/BajajAllianz www.bit.do/bjazgi

 *123368532*

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory and Development Authority of India [IRDAI] vide Regd. No.113)
Regd. Office: Bajaj Allianz House, Airport Road, Yerwada, Pune 411006 (India)

HEALTH GUARD (FLOATER) POLICY SCHEDULE UIN. IRDAI/HLT/BAGI/P-H/V.II/113/16-17

Policy issuing office and Correspondence address for communication Bajaj Finserv Building, 1st Floor, Behind Weikfield ITPark,
by policyholder for claim, service request, notice, summons, etc. Viman Nagar, Pune-411014 Phone No :1800-209-0144
Proposer Name RAJBIR SHARMA Policy Number OG-20-9906-8430-00002581

Special Terms & Conditions NA

Member Name Special Condition Member level
rajbir sharma NA
Special Exclusions
kunika mangla NA
gargi sharma NA
Maternity benefit is applicable for female member/s only.
Additional Remarks Daily Cash for Accompanying an Insured Child benefit is applicable only for children up to 12 years
This is to certify that RAJBIR SHARMA has paid RS.11,275.00 towards Health Insurance for Period
80 D Certificate and Policy Number as mentioned on the Policy Schedule and is eligible for Deduction under Section
80-D of Income Tax (Amendment) Act, 1986
Receipt Number : 9906-02770436 | Date : 22-JUL-19 | Premium Payer ID : 155667591 | Float : CF
Premium Details
** If Premium paid through Cheque, the Policy is void ab-initio in case of dishonour of Cheque
Financial Institution Ref. No. 1212121
Agency Code & Name 10059888/BAJAJ FINSERV DIRECT LIMITED
Contact No. 02071877060 E-Mail insuranceconnect@bajajfinservmarkets.in
For & on the behalf
Bajaj Allianz General Insurance Company Ltd.

This document is digitally signed, hence counter signature / stamp is not

Authorized Signatory required.
Consolidated Stamp Duty of Rs.0.5/- paid towards
Insurance Stamps vide Challan No.
MH000896742201920M Defaced No.
'0000837480201920 dated 13-MAY-19 timing
16:26:27 of General Stamp Office,Mumbai,India.

Principal Location : Bajaj Allianz

House, Airport Road, Yerwada, Pune
- 411006 PH:66026666 | Services
Accounting Code : 997133 -
Accident and health insurance
services. No reverse charge is
payable on these services.
Schedule (1) | Printed on : 26-JUL-2019 10:43:45|bfsdonline@general.bajajallianz.co.in|Web|Sub 10059888 / 0

For help and more information: Page 7 of 11

Contact our 24 Hour Call Centre at 1800-209-5858, 1800-102-5858 (Toll Free)
Email: Bagichelp@bajajallianz.co.in , Website www.bajajallianz.com

Corporate Identification Number: U66010PN2000PLC015329 | Demystify Insurance http://support.bajajallianz.com

http://www.facebook.com/BajajAllianz http://twitter.com/BajajAllianz www.bit.do/bjazgi

 *123368532*

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory and Development Authority of India [IRDAI] vide Regd. No.113)
Regd. Office: Bajaj Allianz House, Airport Road, Yerwada, Pune 411006 (India)

HEALTH GUARD (FLOATER) ANNEXURE

Policy issuing office and Correspondence address for communication Bajaj Finserv Building, 1st Floor, Behind Weikfield ITPark,
by policyholder for claim, service request, notice, summons, etc. Viman Nagar, Pune-411014 Phone No :1800-209-0144
Proposer Name RAJBIR SHARMA Policy Number OG-20-9906-8430-00002581

HEALTH & WELLNESS CARD

HEALTH & WELLNESS CARD

Customer ID : 155667591
Policy No : OG-20-9906-8430-00002581
ID Card No : 20-124695621
Valid Up to : 21-JUL-2020
rajbir sharma (29Yrs.)

Bajaj Allianz General Insurance Company Limited

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance
Regulatory and Development Authority of India[IRDAI] vide Reg No. 113)
Regd.Office: Bajaj Allianz House, Airport Road, Yerwada, Pune-411006 (India)
Cashless hospitalization in network hospitals can be obtained only if this card is
produced along with a letter of authorization from Bajaj Allianz except for emergency
cases. This is subject to terms and conditions of the policy. Please quote your ID number
for assistance. Intimation to Bajaj Allianz Helpline is mandatory in case of any
hospitalization.
HOSPITAL ALERT: In emergency, Patient may approach with id card; please call Bajaj
Allianz helpline to verify coverage and cashless authorization.
For help and more information:
Contact our 24 Hour Call Center at 1800-209-5858 (Toll Free), 30305858
(chargeable,add area code before this number in case of mobile call)
Email: Bagichelp@bajajallianz.co.in, Website www.bajajallianz.com
Corporate Identification Number: U66010PN2000PLC015329

For help and more information: Page 8 of 11

Contact our 24 Hour Call Centre at 1800-209-5858, 1800-102-5858 (Toll Free)
Email: Bagichelp@bajajallianz.co.in , Website www.bajajallianz.com

Corporate Identification Number: U66010PN2000PLC015329 | Demystify Insurance http://support.bajajallianz.com

http://www.facebook.com/BajajAllianz http://twitter.com/BajajAllianz www.bit.do/bjazgi

 *123368532*

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory and Development Authority of India [IRDAI] vide Regd. No.113)
Regd. Office: Bajaj Allianz House, Airport Road, Yerwada, Pune 411006 (India)

HEALTH GUARD (FLOATER) ANNEXURE

Policy issuing office and Correspondence address for communication Bajaj Finserv Building, 1st Floor, Behind Weikfield ITPark,
by policyholder for claim, service request, notice, summons, etc. Viman Nagar, Pune-411014 Phone No :1800-209-0144
Proposer Name RAJBIR SHARMA Policy Number OG-20-9906-8430-00002581

HEALTH & WELLNESS CARD

HEALTH & WELLNESS CARD

Customer ID : 155667592
Policy No : OG-20-9906-8430-00002581
ID Card No : 20-124695621A
Valid Up to : 21-JUL-2020
kunika mangla (25Yrs.)

Bajaj Allianz General Insurance Company Limited

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance
Regulatory and Development Authority of India[IRDAI] vide Reg No. 113)
Regd.Office: Bajaj Allianz House, Airport Road, Yerwada, Pune-411006 (India)
Cashless hospitalization in network hospitals can be obtained only if this card is
produced along with a letter of authorization from Bajaj Allianz except for emergency
cases. This is subject to terms and conditions of the policy. Please quote your ID number
for assistance. Intimation to Bajaj Allianz Helpline is mandatory in case of any
hospitalization.
HOSPITAL ALERT: In emergency, Patient may approach with id card; please call Bajaj
Allianz helpline to verify coverage and cashless authorization.
For help and more information:
Contact our 24 Hour Call Center at 1800-209-5858 (Toll Free), 30305858
(chargeable,add area code before this number in case of mobile call)
Email: Bagichelp@bajajallianz.co.in, Website www.bajajallianz.com
Corporate Identification Number: U66010PN2000PLC015329

For help and more information: Page 9 of 11

Contact our 24 Hour Call Centre at 1800-209-5858, 1800-102-5858 (Toll Free)
Email: Bagichelp@bajajallianz.co.in , Website www.bajajallianz.com

Corporate Identification Number: U66010PN2000PLC015329 | Demystify Insurance http://support.bajajallianz.com

http://www.facebook.com/BajajAllianz http://twitter.com/BajajAllianz www.bit.do/bjazgi

 *123368532*

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory and Development Authority of India [IRDAI] vide Regd. No.113)
Regd. Office: Bajaj Allianz House, Airport Road, Yerwada, Pune 411006 (India)

HEALTH GUARD (FLOATER) ANNEXURE

Policy issuing office and Correspondence address for communication Bajaj Finserv Building, 1st Floor, Behind Weikfield ITPark,
by policyholder for claim, service request, notice, summons, etc. Viman Nagar, Pune-411014 Phone No :1800-209-0144
Proposer Name RAJBIR SHARMA Policy Number OG-20-9906-8430-00002581

HEALTH & WELLNESS CARD

HEALTH & WELLNESS CARD

Customer ID : 155667593
Policy No : OG-20-9906-8430-00002581
ID Card No : 20-124695621B
Valid Up to : 21-JUL-2020
gargi sharma (0Yrs.)

Bajaj Allianz General Insurance Company Limited

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance
Regulatory and Development Authority of India[IRDAI] vide Reg No. 113)
Regd.Office: Bajaj Allianz House, Airport Road, Yerwada, Pune-411006 (India)
Cashless hospitalization in network hospitals can be obtained only if this card is
produced along with a letter of authorization from Bajaj Allianz except for emergency
cases. This is subject to terms and conditions of the policy. Please quote your ID number
for assistance. Intimation to Bajaj Allianz Helpline is mandatory in case of any
hospitalization.
HOSPITAL ALERT: In emergency, Patient may approach with id card; please call Bajaj
Allianz helpline to verify coverage and cashless authorization.
For help and more information:
Contact our 24 Hour Call Center at 1800-209-5858 (Toll Free), 30305858
(chargeable,add area code before this number in case of mobile call)
Email: Bagichelp@bajajallianz.co.in, Website www.bajajallianz.com
Corporate Identification Number: U66010PN2000PLC015329

For help and more information: Page 10 of 11

Contact our 24 Hour Call Centre at 1800-209-5858, 1800-102-5858 (Toll Free)
Email: Bagichelp@bajajallianz.co.in , Website www.bajajallianz.com

Corporate Identification Number: U66010PN2000PLC015329 | Demystify Insurance http://support.bajajallianz.com

http://www.facebook.com/BajajAllianz http://twitter.com/BajajAllianz www.bit.do/bjazgi

 *123368532*

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory and Development Authority of India [IRDAI] vide Regd. No.113)
Regd. Office: Bajaj Allianz House, Airport Road, Yerwada, Pune 411006 (India)

HEALTH GUARD (FLOATER) RECEIPT

Policy issuing office and Correspondence address for communication Bajaj Finserv Building, 1st Floor, Behind Weikfield ITPark,
by policyholder for claim, service request, notice, summons, etc. Viman Nagar, Pune-411014 Phone No :1800-209-0144
Proposer Name RAJBIR SHARMA Policy Number OG-20-9906-8430-00002581

RECEIPT

Receipt Number 9906-02770436

Receipt Date 22-JUL-19
Business Channel WS

Received with thanks from RAJBIR SHARMA

(Customer ID : 155667591) a total sum of Rupees Eleven Thousand Two Hundred Seventy Five Only by,

Instrument Type Instrument No Instrument Date Bank Name Branch Name Amount
Credit Card 7792528 22/07/2019 NA NA 11,275.00
Total Amount 11,275.00
Note :
Issuance of this receipt does not amount of acceptance of the risk by Bajaj Allianz General Insurance Company Limited. The
insurance cover for the risk shall be as per the terms and conditions of the Insurance Policy if and when issued.
* Cheque/DD/PO receipt is valid subject to realisation of the instrument

For & on the behalf

Bajaj Allianz General Insurance Company Ltd.

Authorized Signatory

Regd. Office: Bajaj Allianz House, Airport Road, Yerwada, Pune - 411006

For help and more information: Page 11 of 11

Contact our 24 Hour Call Centre at 1800-209-5858, 1800-102-5858 (Toll Free)
Email: Bagichelp@bajajallianz.co.in , Website www.bajajallianz.com

Corporate Identification Number: U66010PN2000PLC015329 | Demystify Insurance http://support.bajajallianz.com

http://www.facebook.com/BajajAllianz http://twitter.com/BajajAllianz www.bit.do/bjazgi