HDFC ERGO General Insurance Company Limited

Policy No. 2918 2013 1013 0400 002

2918201310130400002 Date: 31/01/2016

To,

MR ELESH RASHMIKANT SHAH

704,J-59, RUSTOMJEE EVERSHINE GLOBAL CITY BLDG NO 58 TO 61 CHS ,
AVENUE-J, NR YAZOO PARK ,VIRAR WEST
DIST -PALGHAR
THANE, 401303
MAHARASHTRA
Mobile No : 9029290650

Dear Customer,

We thank you for choosing HDFC ERGO General Insurance.

Please find enclosed your insurance policy which has been issued on the basis of the information and declaration given by
you.

Home Suraksha Plus is the right insurance plan for you, your home & its contents. Home Suraksha Plus provides coverages
like:

Fire & Allied Perils

Burglary & Theft
Major Medical Illnesses & Procedures
Personal Accident
Loss of Job*

*Loss of Job excludes any voluntary unemployment or voluntary retirement.

To ensure seamless & hassle-free services, we request you to check your contact and other details on your policy
schedule on the basis of which the insurance is issued. In case you find any discrepancy or have any queries,
please call our toll free number 1800 2 700 700.

We once again thank you for choosing HDFC ERGO and welcome you to our growing family of customers.

Regards,

Ankur Bahorey
Head - Retail Business Group

Registered & Corporate Office: 1st Floor, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai - 400020. Customer Service Address: 6th Floor, Leela Business Park, Andheri Kurla Road,
Andheri (E), Mumbai - 400 059. Toll Free : 1800-2-700-700 (Accessible from India only) | Fax : 91 22 6638 3699 | care@hdfcergo.com | www.hdfcergo.com
HDFC ERGO General Insurance Company Limited
POLICY SCHEDULE - Endorsed Copy

Policy No. 2918 2013 1013 0400 002

Home Suraksha Plus Customer Id:100662158132

Proposer Name Mr Elesh Rashmikant Shah Gender Male

Correspondence 704,J-59, RUSTOMJEE EVERSHINE GLOBAL CITY BLDG NO 58 Risk Location J-59,704,,RUSTOMJEE GLOBAL CITY,VIRAR WEST, DIST -
Address TO 61 CHS ,,AVENUE-J, NR YAZOO PARK ,VIRAR WEST,DIST Address PALGHAR,THANE,MAHARASHTRA,401303
-PALGHAR, THANE,MAHARASHTRA,401303

Mobile 9029290650 Phone E Mail eleshshah@gmail.com

Period of Insurance From Date & Time 31/01/2016 19:32 hrs To Date & Time 30/01/2021 Midnight Occupancy Residential

Insured Person's Details

Insured’s Name Date of Birth Basis of Sum Insured
ELESH RASHMIKANT SHAH 27/02/1985 Fixed SI Basis

Insured’s Name Name of Nominee Relation Benefit

ELESH RASHMIKANT SHAH SOURABH RASHMIKANT SHAH BROTHER 100%
Financier Name Loan A/c No. 617092651

Coverage Details & Sum Insured (`)

Section Sum Maximum Section Maximum
Coverage Details Coverage Details Sum Insured
No. Insured Deductible No. Deductible
FIRE AND ALLIED PERILS, EARTHQUAKE
III MAJOR MEDICAL ILLNESS and PROCEDURES 2095898 Nil
AND TERRORISM
I Nil
(A) Building 2095898 PERSONAL ACCIDENT
(B) Contents 523974 (A) Accidental Death 2095898 Nil
BURGLARY, HOUSEBREAKING, THEFT IV (B) Permanent Total Disablement 2095898 Nil
II 1000 100000/Per
(A) Contents 523974 (C) Dependent Child Education Benefit (Max 2 Child) Nil
Child
V LOSS OF JOB (No of EMIs) 3 Nil
In case of co-applicant, benefits under section III & IV ( Major Medical Illness and Procedure & Personal Accident) are limited to 50% of Sum Insured for each insured. Benefit under Section V (Loss of Job) is payable
only to the insured(s) who pays the EMI. In the event both Insured pay EMI the benefit shall be limited to the extent of the EMI, paid towards the loan by each insured. *Under Major Medical Illnesses & Procedures
Section following illnesses are covered : (1) Cancer (2) End Stage Renal Failure (3) Multiple Sclerosis (4) Major Organ Transplant (5) Heart Valve Replacement (6) Coronary Artery Bypass Graft (7) Stroke (8)
Paralysis (9) Myocardial Infarction.In the Policy wordings the list of Major Medical Illnesses and Procedures enlisted under Section III has 18 illnesses/procedures. However please note that the coverage provided to
You under this Policy is restricted only to the above mentioned 9 Major Medical Illnesses and Procedures.
Premium Details (`)
Basic Premium 51167.00
Loadings 0.00
Service Tax (Including Swachh Bharat Cess 0.50% - Rs.255.835) 14.5% 7419.00
Total Premium 58586.00
Payment Details
Cheque No./DD/Fund Transfer Date Bank Name

Special Conditions

List of Endorsements
Endt No Description Effective Date
001 Change in Correspondence details 31/01/2016
002 Change in Correspondence details 31/01/2016

For Claim Services Phone 1800-2700700 Fax no. 66383699 E-mail care@hdfcergo.com
Address
For any other query call toll-free 1800 2 700 700 or email us at care@hdfcergo.com or log on to www.hdfcergo.com

If the premium is not realised the policy shall be void from inception.
The stamp duty of ` 0.5 /- paid by Demand Draft, vide Receipt/Challan no 3942108201617 dated 28/12/2016 as prescribed in Government Notification Revenue and Forest Department No. Mudrank
2004/4125/CR 690/M-1, dated 31/12/2004 , Service Tax Registration No: AABCH0738EST004 .

Policy Issuing Office: Mumbai For HDFC ERGO General Insurance Company Ltd.

Agent Name :HDFC BANK LTD

Agent Code :201587086428 Tel No. : 91-22-28561818 Duly Constituted Attorney
The Policy wording attached herewith includes all the standard coverage offered by the Company to its customers. Your entitlement for coverage/benefits shall be restricted to the coverage/benefits as

Registered & Corporate Office: 1st Floor, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai - 400020. Customer Service Address: 6th Floor, Leela Business Park, Andheri Kurla Road,
Andheri (E), Mumbai - 400 059. Toll Free : 1800-2-700-700 (Accessible from India only) | Fax : 91 22 6638 3699 | care@hdfcergo.com | www.hdfcergo.com
HDFC ERGO General Insurance Company Limited
POLICY SCHEDULE - Endorsed Copy

Policy No. 2918 2013 1013 0400 002

mentioned in this policy schedule. For any clarification please call our toll free number.

Registered & Corporate Office: 1st Floor, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai - 400020. Customer Service Address: 6th Floor, Leela Business Park, Andheri Kurla Road,
Andheri (E), Mumbai - 400 059. Toll Free : 1800-2-700-700 (Accessible from India only) | Fax : 91 22 6638 3699 | care@hdfcergo.com | www.hdfcergo.com
 HDFC ERGO General Insurance Company Limited
Major Medical Illness and Procedures
Policy No. 2918 2013 1013 0400 002

ELESH RASHMIKANT SHAH

704,J-59, RUSTOMJEE EVERSHINE GLOBAL
CITY BLDG NO 58 TO 61 CHS ,,AVENUE-J, NR
YAZOO PARK ,VIRAR WEST,DIST -PALGHAR,
THANE,MAHARASHTRA,401303

Subject : Certificate for the purpose of deduction under section 80 D of Income Tax Act, 1961

This is to certify that we have received an amount of ` 35,701.00 (RUPEES THIRTY-FIVE THOUSAND SEVEN
HUNDRED ONE AND ZERO PAISE Only) towards premium for Major Medical Illness And Procedures Policy
No. 2918201310130400002 issued to ELESH RASHMIKANT SHAH for the period 31/01/2016 to 30/01/2021.

Note: 1. This is subject to the provisions of Section 80D of income tax Act, 1961 as amended from time to time.
2. This certificate must be surrendered to the company in case of cancellation of this policy. In event of incorrect
representation of this declaration the liability shall be upon the policy holder.

Date : 31/01/2016

Policy Issuing Office: Mumbai

For HDFC ERGO General Insurance Company Ltd.

Duly Constituted Attorney

Registered & Corporate Office: 1st Floor, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai - 400020. Customer Service Address: 6th Floor, Leela Business Park, Andheri Kurla Road,
Andheri (E), Mumbai - 400 059. Toll Free : 1800-2-700-700 (Accessible from India only) | Fax : 91 22 6638 3699 | care@hdfcergo.com | www.hdfcergo.com
HDFC ERGO General Insurance Company Limited
Frequently Asked Question’s (FAQ’s) - Home Suraksha Plus

WHAT IS COVERED IN THIS POLICY?

HSP secures your home loan liability to the extent of your sum insured as mentioned in your Section IV – Personal Accident
policy schedule under the sub heads: Section V – Loss of employment, for salaried profiles
Section I – Home Insurance
Section II – Burglary Please refer policy schedule and wordings for details.
Section III – Critical Illness
DO I GET INCOME TAX BENEFIT?
Yes, you get an income tax benefit under Section 80D under Income Tax Act 1961 for the critical illness section for the first year of the policy i.e, in the same financial year in which premium
is paid. Tax deduction certificate for the same is provided along with the policy.
WHAT ARE THE CHECKS TO BE DONE AFTER RECEIVING THE POLICY? WHOM DO I NEED TO CONTACT TO MAKE CHANGES OR CORRECTIONS IN MY POLICY?

Check the correctness and completeness of below points in the policy schedule. 1. You can send dully signed request via any of the below options:
Insured’s name and proposer’s name (salutation, gender, spelling) Fax :022-66383669 / 66383699
Correspondence address (house number, street name, locality, pincode, city, village, Email : care@hdfcergo.com
landmark, etc) Post/courier : Corporate office at Andheri (East) in Mumbai.
Risk location address i.e, address of property insured
Mobile number, landline number and personal email id 2. Call toll free 1800-2-700-700 (accessible from any Mobile and Landline within India) /
Policy period 1800-226-226 (from BSNL/MTNL)
Coverage or sum insured details Please mention your policy number, correspondence address and contact numbers
Date of birth of insured i.e, policy holder in the communication.
Loan account number
Assignment of the policy i.e, hypothecation bank / financier Note: Supporting documents may be called for such corrections whereby change of
Nominee details like name and relationship. premium amount is involved or otherwise in the policy on case to case basis.

WOULD I RECEIVE ANY CONFIRMATION ON THE CHANGES DONE IN MY POLICY?

You would receive an endorsed policy schedule reflecting the changes made in the policy details on your correspondence address as per policy. Same would be captured in the policy
under the section “list of endorsements”.
WHAT DO I DO IN CASE OF A CLAIM?
Call our customer care toll free 1800-2-700-700 (accessible from any Mobile and Landline within India) / 1800-226-226 (from BSNL/MTNL) and register claim & obtain claim ID
Write to care@hdfcergo.com mentioning your policy number, contact details and nature of loss
Note: Claim form would be sent by courier or mail. It is also available under “Claims” section on the home page of our website, www.hdfcergo.com

WHAT ARE THE DOCUMENTS REQUIRED IN CASE OF A CLAIM?

Mandatory documents are For claim under LOSS OF JOB
Duly filled and signed claim form ( available on our website) Certificate / letter from the employer confirming termination, dismissal, temporary
Outstanding loan statement and EMI schedule on the date of loss suspension or retrenchment of insured with reasons and date / period of
unemployment.
Other documents applicable are :
Copy of last three months salary slips
For claim under ACCIDENTAL DEATH New employment letter if already employed with other employer
Police FIR (if accident is reported to police)
For claim under fire insurance or burglary
Death certificate issued by local gram panchayat / municipal corporation
List of items lost in the event with their purchase bill or receipt
Post-mortem reports in case of Road traffic accident
Police FIR / Charge Sheet (notarized copy)
Copy of succession certificate if claimant is other than Nominee
Occupancy certificate (notarized copy)
For claim under PERMANENT DISABILITY or CRITICAL ILLNESS Fire Brigade report (notarized copy)
Invoices (in case available for contents)
Discharge card, discharge summary, Medical certificate, diagnostic reports, indoor Repair Bills (in original)
case papers from hospital, if any
Note: This is not an exhaustive list. Additional docs may be called for on case to case
Attending physician’s statement as per ‘Form D’
basis.
WHOM SHOULD I SEND THE CLAIM DOCUMENTS TO?
Claim documents can be sent to below mentioned customer service office address of HDFC ERGO in Mumbai.
HOW TO CONTACT US?

Toll free : 1800 2 700 700 (Accessible from India only)

Fax : 022 6638 3669
E-Mail : care@hdfcergo.com
Write to us : HDFC ERGO General Insurance Company Limited
(Customer service office) 6th floor, Leela Business Park, Andheri Kurla Road, Andheri (East), Mumbai - 400 059

Manage Your Portfolio View your policy details Track your claims online whenever the need arises
@ hdfcergo.com / Link multiple policies of yourself and your loved ones Raise service request / complaints & set renewal reminders
Change your personal details on the go Information about branches, garages and hospitals
Smartphones*
* supports smart phones based on Blackberry, iPhone, Android & Symbian platforms

This document is a summary of the benefits offered. The information mentioned above is illustrative and not exhaustive. Information must be read in conjunction with the policy wordings.
In case of any conflict between this document and the policy wordings, the terms and conditions mentioned in the policy wordings shall prevail.