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Name Age Gender Relation EmpCode

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Hari Krishna Dorsala 31yrs Male Self 17807

24 Hour Toll Free Call Centre 1800-425-9449 - Accessible through BSNL / MTNL land Lines only. - This card is only for identification purpose and is not an authorisation to proceed with the treatment or a guarantee for payment. - Subject to the terms and conditions of the underlying insurance policy, this non transferable identification card valid at selected hospitals will enable you to avail Cashless hospitalisation only on the basis of preauthorisation issued by Medi Assist. - In Case preauthorisation is not issued,the policy holder / beneficiary will be required to make payments to hospital and submit the claim to Medi Assist for a possible reimbursement. - All preauthorisation and/or settlement of claims is subject to the terms and conditions of the relevant policy. Please note the following 1. This soft copy of Medi Assist Identity card is valid for identification when printed and presented with a valid proof of identity at any Medi Assist Network Hospital. 2. All non admissible expenses incurred have to be paid directly to the hospital by the employee. 3. This card is valid only for hospitalization in India. 4. Along with this card acceptable proof of identity such as IDCard of the Employee only issued by the employer / Passport / Driver's Licence / Ration Card / Voter IDCard / PAN Card should be presented at the Hospital. 5. Copy of this eCard signed by patient or a family member covered under the policy should be sent to Mediassist along with the filled & signed Pre-Authorization form.

ADDRESS: MEDI ASSIST INDIA PVT.LTD 3rd Floor,No.49 shilpa Vidya,Sarakki Industrial Layout,1st Main Road, J P Nagar 3rd Stage, Bangalore - 560 078. Ph:(080)26584811,Fax:(080)26584812. www.mediassistindia.com

Name Age Gender Relation EmpCode

: : : : :

Sirisha D 24yrs Female Spouse 17807

24 Hour Toll Free Call Centre 1800-425-9449 - Accessible through BSNL / MTNL land Lines only. - This card is only for identification purpose and is not an authorisation to proceed with the treatment or a guarantee for payment. - Subject to the terms and conditions of the underlying insurance policy, this non transferable identification card valid at selected hospitals will enable you to avail Cashless hospitalisation only on the basis of preauthorisation issued by Medi Assist. - In Case preauthorisation is not issued,the policy holder / beneficiary will be required to make payments to hospital and submit the claim to Medi Assist for a possible reimbursement. - All preauthorisation and/or settlement of claims is subject to the terms and conditions of the relevant policy. Please note the following 1. This soft copy of Medi Assist Identity card is valid for identification when printed and presented with a valid proof of identity at any Medi Assist Network Hospital. 2. All non admissible expenses incurred have to be paid directly to the hospital by the employee. 3. This card is valid only for hospitalization in India. 4. Along with this card acceptable proof of identity such as IDCard of the Employee only issued by the employer / Passport / Driver's Licence / Ration Card / Voter IDCard / PAN Card should be presented at the Hospital. 5. Copy of this eCard signed by patient or a family member covered under the policy should be sent to Mediassist along with the filled & signed Pre-Authorization form. ADDRESS: MEDI ASSIST INDIA PVT.LTD 3rd Floor,No.49 shilpa Vidya,Sarakki Industrial Layout,1st Main Road, J P Nagar 3rd Stage, Bangalore - 560 078. Ph:(080)26584811,Fax:(080)26584812. www.mediassistindia.com

Name Age Gender Relation EmpCode

: : : : :

Haasini 3yrs Female Daughter 17807

24 Hour Toll Free Call Centre 1800-425-9449 - Accessible through BSNL / MTNL land Lines only. - This card is only for identification purpose and is not an authorisation to proceed with the treatment or a guarantee for payment. - Subject to the terms and conditions of the underlying insurance policy, this non transferable identification card valid at selected hospitals will enable you to avail Cashless hospitalisation only on the basis of preauthorisation issued by Medi Assist. - In Case preauthorisation is not issued,the policy holder / beneficiary will be required to make payments to hospital and submit the claim to Medi Assist for a possible reimbursement. - All preauthorisation and/or settlement of claims is subject to the terms and conditions of the relevant policy. Please note the following 1. This soft copy of Medi Assist Identity card is valid for identification when printed and presented with a valid proof of identity at any Medi Assist Network Hospital. 2. All non admissible expenses incurred have to be paid directly to the hospital by the employee. 3. This card is valid only for hospitalization in India. 4. Along with this card acceptable proof of identity such as IDCard of the Employee only issued by the employer / Passport / Driver's Licence / Ration Card / Voter IDCard / PAN Card should be presented at the Hospital. 5. Copy of this eCard signed by patient or a family member covered under the policy should be sent to Mediassist along with the filled & signed Pre-Authorization form. ADDRESS: MEDI ASSIST INDIA PVT.LTD 3rd Floor,No.49 shilpa Vidya,Sarakki Industrial Layout,1st Main Road, J P Nagar 3rd Stage, Bangalore - 560 078. Ph:(080)26584811,Fax:(080)26584812. www.mediassistindia.com

Name Age Gender Relation EmpCode

: : : : :

Venkateswara Reddy.D 59yrs Male Father 17807

24 Hour Toll Free Call Centre 1800-425-9449 - Accessible through BSNL / MTNL land Lines only. - This card is only for identification purpose and is not an authorisation to proceed with the treatment or a guarantee for payment. - Subject to the terms and conditions of the underlying insurance policy, this non transferable identification card valid at selected hospitals will enable you to avail Cashless hospitalisation only on the basis of preauthorisation issued by Medi Assist. - In Case preauthorisation is not issued,the policy holder / beneficiary will be required to make payments to hospital and submit the claim to Medi Assist for a possible reimbursement. - All preauthorisation and/or settlement of claims is subject to the terms and conditions of the relevant policy. Please note the following 1. This soft copy of Medi Assist Identity card is valid for identification when printed and presented with a valid proof of identity at any Medi Assist Network Hospital. 2. All non admissible expenses incurred have to be paid directly to the hospital by the employee. 3. This card is valid only for hospitalization in India. 4. Along with this card acceptable proof of identity such as IDCard of the Employee only issued by the employer / Passport / Driver's Licence / Ration Card / Voter IDCard / PAN Card should be presented at the Hospital. 5. Copy of this eCard signed by patient or a family member covered under the policy should be sent to Mediassist along with the filled & signed Pre-Authorization form. ADDRESS: MEDI ASSIST INDIA PVT.LTD 3rd Floor,No.49 shilpa Vidya,Sarakki Industrial Layout,1st Main Road, J P Nagar 3rd Stage, Bangalore - 560 078. Ph:(080)26584811,Fax:(080)26584812. www.mediassistindia.com

Name Age Gender Relation EmpCode

: : : : :

Vijayalaxm.D 49yrs Female Mother 17807

24 Hour Toll Free Call Centre 1800-425-9449 - Accessible through BSNL / MTNL land Lines only. - This card is only for identification purpose and is not an authorisation to proceed with the treatment or a guarantee for payment. - Subject to the terms and conditions of the underlying insurance policy, this non transferable identification card valid at selected hospitals will enable you to avail Cashless hospitalisation only on the basis of preauthorisation issued by Medi Assist. - In Case preauthorisation is not issued,the policy holder / beneficiary will be required to make payments to hospital and submit the claim to Medi Assist for a possible reimbursement. - All preauthorisation and/or settlement of claims is subject to the terms and conditions of the relevant policy. Please note the following 1. This soft copy of Medi Assist Identity card is valid for identification when printed and presented with a valid proof of identity at any Medi Assist Network Hospital. 2. All non admissible expenses incurred have to be paid directly to the hospital by the employee. 3. This card is valid only for hospitalization in India. 4. Along with this card acceptable proof of identity such as IDCard of the Employee only issued by the employer / Passport / Driver's Licence / Ration Card / Voter IDCard / PAN Card should be presented at the Hospital. 5. Copy of this eCard signed by patient or a family member covered under the policy should be sent to Mediassist along with the filled & signed Pre-Authorization form. ADDRESS: MEDI ASSIST INDIA PVT.LTD 3rd Floor,No.49 shilpa Vidya,Sarakki Industrial Layout,1st Main Road, J P Nagar 3rd Stage, Bangalore - 560 078. Ph:(080)26584811,Fax:(080)26584812. www.mediassistindia.com