Page 1 :
HDFC ERGO General Insurance Company Limited, , 2952203125110600000, , Mr Arun Kumar Mishra, H No-K4 Saraswati Kunj Chipyana Khurd Police, Station Bisrakh Teh-Dadri Gautam Budha Ngr, Syndicate Ban . Noida, 201307, Uttar Pradesh, Contact No : 9717852085, Date : 15/11/2019, Dear Mr Arun Kumar Mishra, Thank you for choosing HDFC ERGO as your preferred insurance partner. We welcome you to be a part of our family !, Your Health insurance policy reference no 2952203125110600000 is confirmed on the basis of the information and declaration given by you., The details of coverage are mentioned in the enclosed policy schedule of insurance., As a measure of our customer convenience we have implemented a Lifetime Validity Health Card. For you, this simply means that your Health Card is valid for all subsequent, renewals and as long as your policy is active with us. Hence, you need not replace your health card every year, We value your relationship with us and assure you our best services at all times and we look forward to serve you., Now you can view your policy details and health card at your fingertips. Download our Mobile App now and experience convenience today!!, For HDFC ERGO General Insurance Company Ltd., , Ankur Bahorey, Head - Retail Business Group, , HDFC ERGO General Insurance Company Limited, , 2952203125110600000, , TAX CERTIFICATE, Dear MR ARUN KUMAR MISHRA, Subject : Certificate for the purpose of deduction under section 80 D of Income Tax (Amendment) Act, 1986, This i s to certify that we have received an amount of ` 16087 towards premium for Health Suraksha Policy , Policy No. 2952203125110600000 issued to for the, period 15/11/2019 to 14/11/2020., Note : This is subject to the provisions of Section 80D of income tax (Amendment) Act, 1986 as amended from time to time., 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 : 15/11/2019, , For HDFC ERGO General Insurance Company Ltd., , Policy Issuing Office: Mumbai, Duly Constituted Attorney, , HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146, CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House,, 165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020., , UIN: HDFHLIP20049V041920. Customer Service Address: D 301, 3rd Floor,, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078., Customer Service No : +91 22-62346234/+91-120 6234 6234 | www.hdfcergo.com

Page 2 :
HDFC ERGO General Insurance Company Limited, POLICY SCHEDULE, , my: health Suraksha Policy, Silver Smart, , 2952203125110600000, , Mr Arun Kumar Mishra, H No-K4 Saraswati KunjChipyana Khurd Police, StationBisrakh Teh-Dadri Gautam Budha Ngr Syndicate, Ban .Noida, Uttar Pradesh, 201307, Contact No : 9717852085, , Policy No., Period of Insurance, Invoice No., HSN Code, Proposer Name, Customer Id, , :2952 2031 2511 0600 000, Issuance Date, :15/11/2019, :From 15/11/2019 19:45 hrs To 14/11/2020 Midnight, :203125110600000, Premium Frequency, :Yearly, :997133, Policy Type, :Family Floater, :Mr Arun Kumar Mishra, PAN, :100266306902, , Payment Details : ERGO_CC_15112019 , Date: 15/11/2019, Bank Name:HDFC Bank Ltd, Email ID : [email protected], Insured Person’s Details & Sum Insured, DOB, Nominee Name, Nominee, 1st Policy, Relationship Inception, , Insured's Name, , Relation with Gender, policy holder, , Arun Kumar Mishra, , Self, , Male, , 25/02/1990 PINKI MISHRA, , Advik Mishra, , Son, , Male, , 25/03/2019, , 15/11/2019, , Saanvi Mishra, , Daughter, , Female 22/03/2016, , Pinki Mishra, , Wife, , Female 11/07/1990, , Spouse, , Basic Sum Tier, Insured (`), , CB Amount, (`), , 500000, , 0, , NO, , 0, , NO, , 15/11/2019, , 0, , NO, , 15/11/2019, , 0, , NO, , 15/11/2019, , Tier 2, , Pre, Existing, Disease, , Schedule of Coverage, Section, , Covers, , Details/ Applicability of Sum Insured, Base Covers, up to Basic Sum Insured including cumulative Bonus, , A, 1B, 2, 3, 4, 5, 6, 7, , Hospitalization Cover, Medical Expenses, Mental Healthcare, Home Healthcare, Domiciliary Hospitalization, Pre-Hospitalization, Post-Hospitalization, Day Care Procedures, Road Ambulance cover, , 8, 9, C1, , Organ Donor Expenses, Alternative Treatment, Preventive Health Check Up -Booster, , upto Basic Sum Insured including cumulative Bonus, upto Basic Sum Insured including cumulative Bonus, over and above the Basic Sum Insured, , C5, C6, C11, , Recovery Benefit, Sum Insured Rebound, Waiting Period Modification Option, , over and above the Basic Sum Insured, over and above the Basic Sum Insured, Reduction in the standard waiting period as opted for, , 1, 2, , Cumulative Bonus, my:health Active, , Applicable, Applicable, , Hospitalization Cover, , Sec E 1 i - General waiting period - 30 days from Policy inception date, Sec E 1 ii - Listed illness & procedures - 24 Months, Sec E 1 iii - Preexisting conditions - 36 Months, , Sub limited within the Basic Sum Insured including, Cumulative Bonus, , Limit, Basic Sum Insured and CB, Basic Sum Insured and CB, Basic Sum Insured and CB, Basic Sum Insured and CB, Basic Sum Insured and CB, 60 Days, 180 Days, Basic Sum Insured and CB, SI 1 to 5 L -2,000, SI 6 to 50 L -3,500, SI Above 50 L -15,000, Basic Sum Insured and CB, Basic Sum Insured and CB, Covered Up to 1% of Basic Sum Insured max upto, Rs 5,000, on every renewal, 5000, Upto 100% of Basic Sum Insured, 3 Years, , Renewal Benefits, , Waiting Periods, Section A, , Premium Details, , (`), , Basic Premium, , 13,633.00, , Loadings, , 0.00, 2,454.00, 16,087.00, , Integrated Tax 18%, Total Premium, For Claim/Policy related queries call us at +91- 22 6234 6234/+91- 120 6234 6234 or Visit Help Section on www.hdfcergo.com for policy copy/tax certificate/make changes/register & track claim., , If the premium is not realised the policy shall be void from inception.Consolidated stamp duty for this Insurance Policy is paid by Demand Draft, vide Receipt/Challan no CSD/173/2019/4788 dated 09/10/2019 as, prescribed in Government of Maharashtra Order No. Mudrank-2017/CR.97/M-1, dated the 09th January 2018". GST Registration No: 07AABCL5045N1ZA. GST for this invoice is not payable under reverse, charge basis., Branch :unit no 502,504,506, 5th fl, mahatta tower 54, b-1 block, community centr west delhi, Write to us : [email protected], For HDFC ERGO General Insurance Company Ltd., , Agent Name :HDFC BANK LTD Agent Code :201587086428 Tel No. : 91-22-61606161, Duly Constituted Attorney, , HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146, CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House,, 165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020., , UIN: HDFHLIP20049V041920. Customer Service Address: D 301, 3rd Floor,, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078., Customer Service No : +91 22-62346234/+91-120 6234 6234 | www.hdfcergo.com, , 0

Page 3 :
HDFC ERGO General Insurance Company Limited, , HDFC ERGO General Insurance Company Limited, Policy No.:2952203125110600000, Valid From: 15/11/2019 Renewal Date: 14 November, , Insured Name, SAANVI MISHRA, ADVIK MISHRA, ARUN KUMAR MISHRA, PINKI MISHRA, , Date Of Birth, , Gender, , 22/03/2016, 25/03/2019, 25/02/1990, 11/07/1990, , Female, Male, Male, Female, , This card is for identification purpose only., Card has to be presented to the Network Service Provider at the time of admission/ availing, cashless hospitalization o r any other services. Insurance claim will be processed in accordance, with the policy term & conditions. Card does not guarantee cashless hospitalization or any other, service. For more details and updated list of Network Service Provider please refer our website or, call our call centre. This card is valid till the time policy is active., Customer Service No :, Fax Number, :, Email, :, Processing Centre :, Website, , HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146, CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House,, 165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020., , 022 - 6234 6234 / 0120 - 6234 6234, 022 - 6234 6234/0120 - 6234 6234, [email protected], HDFC ERGO General Insurance Company Ltd. 5th floor,, Tower 1, Steller IT Park, C-25, Sector-62,Noida-201301., : www.hdfcergo.com, , UIN: HDFHLIP20049V041920. Customer Service Address: D 301, 3rd Floor,, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078., Customer Service No : +91 22-62346234/+91-120 6234 6234 | www.hdfcergo.com, , 4

Page 4 :
HDFC ERGO General Insurance Company Limited, , Section, , Customer, Response, , Transcript Between Our Customer Executive and Policy Holder, , Good Morning Sir / Madam, Am I speaking to Mr/ Ms. ARUN KUMAR MISHRA on Phone no 9717852085? I am barkha.agrawal & AV certificate no.164882 calling on behalf of HDFC Bank, having Corporate Agency code -CA0010 This call is regarding the "my:health Suraksha Silver Smart " insurance policy offered to HDFC bank Credit Card customers by HDFC ERGO, General Insurance Co ltd.Should we continue?, Sir Please let us know the preffered language i.e English, Hindi or local language, Introduction, Sir/ Madam, we would like to inform you that your consent will be recorded for processing the issuance of policy and we shall be also sending the transcript of this conversation along with, the policy documents. The call recording is available wtih us for any future reference., Sir / Madam - are you voluntarily enrolling yourself / your family to the policy without ANY OFFERS?", Commission from General Insurance - Health Insurance is 15%, This Insurance is an annual / 2 year and 3 year policy..This policy is a "my:health Suraksha Silver Smart" provided exclusively for HDFC Bank customers., 1. Health Insurance of Rs (3L/4L/5L) lacs [ sum insured ] on floater basis, which gives you cashless mediclaim facility in more than 9500+ network hospitals all over India.Updated network, hospital list is available on our company's website : WWW.HDFCERGO.COM If the treatment is undertaken in a non-network hospital, you get reimburesement of your hospitalization, expenses within 10 Working days after submission of all documents.The policy also covers ayurvedic, homeopathic and Unani treatments in addition to allopathic treatments. Policy also, covers Organ donor expenses..586 Day care Procedures, This policy also includes Pre & Post Hospitalization expenses [60 days before hospitalisation and 180 days after hospitalisation] and emergency ambulance charges of Upto Rs.2,000 per, event, This policy doesn't cover any pre-existing diseases which you or any of the family member is or has been suffering from until a waiting period of 36 months, This policy has a waiting period for 2 years for medical conditions like Hernia, Cataract, Piles, gall bladder stone & kidney stones. This list is not exhaustive, the complete list is mentioned in, the policy document., Also please note that the policy will not cover any medical hospitalization for first 30 days, however Accidental hospitalization will be covered from day one., Minimum 24 hours of hospitalization is required for all inpatient treatment, Maternity , dental & cosmetic surgery are not covered in this policy. Dental treatment and Cosmetic surgery arising out of accident is covered, 2.Rebound Benefit: Under this benefit we will add to the sum Insured, an amount equivalent to the admissible Claim amount under the Policy subject to maximum of Basic Sum Insured, provided that., 1.Sum Insured added under this cover can be used only for Claim under subsequent Hospitalization of the Insured Person during Policy Year., 2.In case of treatment for Chemotherapy and Dialysis, Sum Insured Rebound will be applicable only once in lifetime of Policy., 3.Any unutilized amount of Sum Insured Rebound cannot be carried over to next policy year., 4. This cover will be applicable annually for policies with term more than one year., 3.Cumulative Bonus: Under this benefit the basic sum insured of your policy cover will increase by 10% for every claim free year up to 100% of basic sum insured and will decrease by 10%, Product in case of a claim, features, 4. Recovery Benefit will be paid when there is a Minimum Hospitalisation of 10 continuous and consecutive days .Recovery Benefit of Rs. 5000 as specified, These were the terms and condition of "Health insurance" product which we have offered to you, hope you have understood the same. We have other add on covers like my: health Hospital, Cash Benefit Add On, which may be opted at additional premium.Some of the addon coverage we will explain you now.May I proceed, We also would like to inform you that we offer life long renewability on this product., Thank you so much for your valuable time to listen to our terms and condition of addon hope you have understood the same.We have other add on covers like Hospital Cash,Critical Illness, which may be opted at additional premium. This cover shall be applicable for the Eldest member of the family, Thank you so much for your valuable time given to us, to explain the features of the products offered., Dear Sir/Madam If our underwriter refers you for any Pre Policy Checkup then the entire cost for check ups will be borne by us & if Diagnostic center offers Home visit service then the same, will also not be charged., Premium Tier-for my:health Suraksha :Sir / Madam for the purpose of policy issuance, the premium is computed basis the city of residence provided by You . However you also have an, option to choose a higher or lower Tier premium .Kindly note the conditions applicable for the same, Classification of cities would be as under: Tier 1a: Delhi and NCR region, Tier 1b: Mumbai, Mumbai Suburban and Navi Mumbai, Pune, Surat, Ahmedabad, Varodara,Tier 2: Rest of India, Conditions: i. On payment of Tier 1a premiums, an Insured Person can avail treatment all over India without any copayment., ii. On payment of Tier 1b premium, an Insured Person can avail treatment at Tier1b cities and Tier 2 cities without any Co-Payment. However if an Insured Person avails a treatment in Tier, 1a cities,20% Co-Payment shall be applicable on admissible claim amount., iii. On payment of Tier 2 premium, an Insured Person can avail treatment at Tier 2 cities without any Co-Payment. However if an Insured Person avails a treatment in Tier 1a cities, 20%, Co-Payment shall be applicable on admissible claim amount., iv. Co-Payment under ii and iii above will not be applied If an Insured Person opts for Hospitalization with Room Rent up to Rs 2,500 per day or on Hospitalization for Medically Necessary, treatment following an Accident, Family, details, , 1, , We would like to confirm the details of the Persons covered within the Policy:, Name of Insured, ARUN KUMAR MISHRA, PINKI MISHRA, SAANVI MISHRA, ADVIK MISHRA, , Relationship, Self, Wife, Daughter, Son, , Date of Birth, 25/02/1990, 11/07/1990, 22/03/2016, 25/03/2019, , Name of Nominee, PINKI MISHRA, , OK, OK, , Yes, , OK, , Relationship with Insured, Spouse, , Have any of the persons proposed to be insured ever suffered from/currently suffering from any diseases, ailments, medical conditions or illnesses, accidents or injury?, PreWhether the given insured is suffering from Diabetes ?, existing, declaration Whether the given insured is suffering from Hypertension ?, Sir / Madam hope all the above information is true to the best of your knowledge, since any miss representation of facts can lead to rejection at the time of claims., Dear Sir/Madam, The Company will confidentially retain personal information and health details provided by you. However, to assess and underwrite the risk, issuance of policy and claim, settlement, the Company may disseminate the same with insurance intermediaries like TPA or Insurance repositories or and other service provider(s)., Yes/No, :, The premium amount for your insurance policy is Rs. 16087 for 1 Year., There will not be any refund of policy premium amount post expiry of the policy. Kindly note, in case of cancellation request during policy period,termination clause mentioned in the policy, clause will be applicable., Should we debit this amount and issue the policy?, I hope you are aware about the fees to be charged by HDFC Bank, details of which are available on HDFC Bank website. Should we instruct HDFC Bank to debit the premium amount and, the processing fee from your account. Premiums are based on the age of the insured. In case of a family floater, the premium is as per the eldest insured of the family. Any change in the, Authorisa premium will be as per the premium tables approved by IRDA.There will not be any refund of policy premium amount post expiry of the policy.Kindly note, in case of cancellation request, during policy period, termination clause mentioned in the policy clause will be applicable., tion, Thank you Sir/Madam, we will issue your policy and the premium will reflect in your HDFC Bank statement. Request you to please maintain the Credit Card limit upto premium of Rs.16087, Premium in your HDFC Bank Credit Card amount so that your request can be processed., You will be entitled for a Free Look period of 15 days from the date of receipt of the policy to review its terms and conditions. In case you disagree with or object to any terms or conditions of, the Policy, you have an option to request for cancellation of the policy stating the reasons for cancellation. The premium paid by you will be refunded after deducting the expenses incurred, by HDFC ERGO on medical check - up, stamp duty charges and proportionate risk premium., Your insurance cover starts from the date of debit of the premium amount from your Credit Card, and it is 1 Year policy to be renewed after every 1 Year to enjoy the benefits., Your Credit Card limit will be blocked to extent of premium amount .We will make 3 attempts in next 30 days to debit the premium amount from your credit card account., Dear Sir/Madam, Also Would like to inform you that there are no freebees provided along with this policy, Sir/Madam, can you please confirm if you have understood the terms and conditions under the policy? Please reconfirm that all the information provided are accurate enabling us to issue &, dispatch the policy to you., May I confirm your DOB details, Closure Thank you very much for re-confirming the details. You will receive your policy document within 15 working days by courier on your credit card mailing address. On the basis of the, information and confirmation given by you HEALTH SURAKSHA SILVER SMART plus insurance policy detailing the terms and conditions shall be issued to you in due course., For further information about the policy, please refer policy terms and conditions sent with the policy schedule or log on to www.hdfcergo.com, Is there anything else you would like us to assist you with? Thank you & Have a nice day!, , HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146, CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House,, 165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020., , OK, , UIN: HDFHLIP20049V041920. Customer Service Address: D 301, 3rd Floor,, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078., Customer Service No : +91 22-62346234/+91-120 6234 6234 | www.hdfcergo.com, , OK, Yes/No, Yes/No, OK, , Yes, , OK, , OK, OK, OK, OK, , OK, OK, OK

Page 5 :
HDFC ERGO General Insurance Company Limited, , FREE HEALTH CHECK UP COUPON, This coupon entitles a free health check up to the insured under the Health Insurance Policy, ■ Medical Examination, , ■ Urine Routine, , ■ Complete Blood Count, , ■ ECG, , ■ Total Cholesterol, , ■ Creatinine, , ■ Fasting Blood Sugar, , Submit this coupon with Hospital / Diagnostic Center, Name of Insured:, , Policy Number:, , □, , PINKI MISHRA, , □, , SAANVI MISHRA, , □, , ADVIK MISHRA, , □, , ARUN KUMAR MISHRA, , 2952203125110600000, , Policy Start Date: 15/11/2019, , Health Check up Date:, Authorization :, Customer Contact:, , Customer Signature :, , Valid upto:, , I am proposor, , (Hospital seal with sign), , Terms & Conditions, The Free Check Coupon is non-transferable and cannot be clubbed with any other offer from the Service Provider / Hospital / Nursing Home, The offer is valid only if the policy is, in force. HDFC ERGO General Insurance Co. Ltd. (“HDFC ERGO”) is entitled to refer the health check report. This Health Check Coupon can only be availed by any one insured, member under the health insurance policy of HDFC ERGO. The administration of this offer is brought to you by Health Claim Services. To avail this offer, the insured is required, to carry the policy copy along with this coupon while going for the health checkup. Coupon is valid up to 180 days from the below mentioned date on the coupons. In case of, cancellation of the health policies, where health coupons have been issued and also used by the insured, health coupons charges shall be deducted while refunding the premium., HDFC ERGO is not responsible or liable for medical reports issued by the Service Provider / Hospital / Nursing Home., , Note:, , ■, ■, ■, ■, ■, ■, , Coupon cannot be clubbed with any other offer from the service provider or hospital/nursing home, Coupon is valid only if policy is in force, Coupon validity period is mentioned on the coupon, Tests are fixed for a particular coupon denomination, Coupon has one time use meaning it can be used in a single visit, Coupon can be used by a single insured, Coupon will be valid for a period of 180 days from the below mentioned date, 31/12/2019, , HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146, CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House,, 165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020., , UIN: HDFHLIP20049V041920. Customer Service Address: D 301, 3rd Floor,, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078., Customer Service No : +91 22-62346234/+91-120 6234 6234 | www.hdfcergo.com