Navi Gi PolicyDocumentSA006T0V

Navi Health Insurance Policy
Policy Schedule
Policyholder Name DATTAM VENKATESWARLU
Policyholder Id PH00327061
Policy Issued On 25/03/2023
UIN No NAVHLIP22133V012122
Policy No SA006T0V
Policy Valid Upto 24/03/2024
Insurance Agent/Intermediary Details
Name Direct Digital
Code P040203000
Contact No. +91 81475 44555

Insured Person Details
Member ID: SA006T0V-01
Insured Person Name DATTAM VENKATESWARLU
Relation with Policyholder Self
Date of Birth (DD/MM/YYYY) 12/02/1992
Age(Years) 31
Gender MALE
First Enrolment Date 25/03/2023
Waiting Periods 0 - 10L
Pre Existing Disease 12 MONTH
30 days waiting period Applicable

Specific Disease/ Procedure 12 MONTH
Insured Person Details
Member ID: SA006T0V-02
Insured Person Name CHINTHALA VANI
Relation with Policyholder Spouse
Age(Years) 27
Gender FEMALE
First Enrolment Date 25/03/2023
Waiting Periods 0 - 10L
Pre Existing Disease 12 MONTH

30 days waiting period Applicable
Specific Disease/ Procedure 12 MONTH
Maternity Benefit Waiting period
Applicable 3 Year
Premium Details
Premium ₹ 12,311
Loading ₹0
Discounts ₹ 3,759.66
Total Premium ₹ 8,551.34
GST @ 18% ₹ 1,539.24
Total Amount (inlc GST) ₹ 10,090.58

Premium Certificate
This is to certify that DATTAM VENKATESWARLU

has paid a total amount of ₹ 840.88 towards
premium for this policy effective from 01:55 Hrs
on 25/03/2023.
Monthly Instalment amount 840.88
Monthly instalment due date 25th of every month
First instalment paid date 25/03/2023
Last instalment due date 25/02/2024
For the purpose of deduction under section 80 D

of Income Tax Act, 1961 and any amendments
thereafter
Scope of Cover
Type Family Floater
Plan Select
Base Medical Cover Amount ₹ 1000000
Medical Cover Amount (Base + Cumulative

Bonus)
₹ 1000000
In-patient Hospitalisation
Up to 100% of medical cover
Wellness Benefits Covered
Post-Hospitalisation 180 Days

Emergency Road Transportation
Pre-Hospitalisation 90 Days
Air Ambulance Covered upto 5 lakhs
Home Hospitalisation Cover
Non payable expenses
Organ Donor Expenses
Additional Medical Cover Amount for Accidental

injury
Newborn Baby Cover Up to ₹ 10,000
Maternity Cover Up to ₹ 30,000

Policy Service Office
Name Navi General Insurance Limited
Date of Signature of Proposal 24/03/2023
Receipt Number
Place of Supply Bangalore
State Code
HSN No 997133
Stamp Duty
The Stamp Duty of Rs. 0.50 paid vide defaced no.

BNGAUG2020136720 dated 22/10/2021
Address
Navi General Insurance Limited

Registered & Corporate Office: NAVI GENERAL
INSURANCE LIMITED, AMR Tech Park, Ground
Floor, No 23 & 24, Hosur Road, Bommanahalli,
Bangalore- 560068
Policy Servicing Office :NAVI GENERAL

INSURANCE LIMITED, AMR Tech Park, Ground
Floor, No 23 & 24, Hosur Road, Bommanahalli,
Bangalore- 560068
Document Digitally Signed
(Bhagwat Sattadhish)
Claim Service Office
TPA Name Navi Health Insurance claims
Toll Free Number 8147544555
Email [email protected]
TPA Address
Navi General Insurance Limited Registered &

Corporate Office: NAVI GENERAL INSURANCE
LIMITED, AMR Tech Park, Ground Floor, No 23 &
24, Hosur Road, Bommanahalli, Bangalore-
560068.
Important Note
This Schedule, Policy terms and conditions and
Endorsement shall be read together and word or expression
to which a specific meaning has been attached in any part
of Navi Health Insurance policy or of the Schedule shall
bear the same meaning wherever it may appear. Any
amendments/modifications/ alterations made on this
system generated policy document is not valid and
Company shall not be liable for any liability whatsoever
arising from such changes. Any changes required to be
made in the policy once issued, would be valid and
effective, only after written request is made to the Company
and Company accepts the requested amendments/
modifications/alterations and records the same through
separate endorsement to be issued by the Company. Our
policy wordings, grievance redressal procedure and details
about ombudsman is also available on our website. Please
note that any misrepresentation, non-disclosure or
withholding of material facts will lead to cancellation of
policy ab initio with forfeiture of premium and non-
consideration of claim, if any.
Transcript of Navi Health Proposal Form
This Insurance policy has been issued on the basis

of the information provided by you. In case of
discrepancy in the below information, you may
please write to us on [email protected]
within 15 days of the receipt of the Policy,
otherwise below information will be deemed as
correct.
Proposer Details
Name DATTAM VENKATESWARLU
Date of Birth 12/02/1992

Plan Details
Tenure 1 Year
Period 25/03/2023 to 24/03/2024
Type Family Floater
Sum Insured ₹ 1000000
Plan Select
Additional Coverages Opted
Newborn Baby Cover Up to ₹ 10,000
Maternity Cover Up to ₹ 30,000

Insured Details - Member
Name DATTAM VENKATESWARLU
Gender MALE
Relation with Proposer Self

Insured Details - Member
Name CHINTHALA VANI
Gender FEMALE
Relation with Proposer Spouse

Medical & Health Information
1.Do you have any existing illnesses or history of

hospitalisation due to an illness?
No
✓ I/We hereby declare that I have read and understood the

mentioned Terms & Conditions. I/We confirm compliance to
AML guidelines
I hereby consent that the Policy Documents shall be sent to
me by e-mail only on my registered e-mail Id. I understand
that this authorisation can berevoked by me at the time of
renewal by contacting your branch office personally or
customer care by writing a mail/ calling your toll-free
number.
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.
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 insurer and that the
policy will come into force only after full payment of the
premium chargeable.
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 been submitted
but before communication of the risk acceptance by the
company.
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 be insured/proposer or
from any past or present employer concerning anything
which affects the physical or mental health of the person to
be insured/proposer and seeking information from any
insurer to whom an application for insurance on the person
to be insured /proposer has been made for the purpose of
underwriting the proposal and/or claim settlement.
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 the proposal
and/or claims settlement and with any Governmental and/
or Regulatory authority.”
Any GST liability and payment for the same is dependent on
the details (viz GSTIN, address, zero-rating entitlement etc)
provided by me. Navi General Insurance Limited will rely on
such information for the purpose of compliance with
applicable GST regulations and shall not be under
obligation to evaluate authenticity/accuracy of the same.
Further, in case any GST liability (in terms of tax, interest,
penalty and associated litigation cost) arises on Navi
General Insurance Limited on account of any incorrect/
incomplete/ non-compliance on behalf of me. I will be
immediately liable to pay the same on notification by Navi
General Insurance Limited. The said liability shall vest
irrespective of the completion of the insurance period
covered within the policy contract.
I hereby consent to and authorize Navi General Insurance
Limited to make welcome calls, service calls or any other
communication (electronic or otherwise) with respect to the
proposed or existing policy of the Company from time to
time.
I/We hereby confirm that all premiums have been/will be
paid from bonafide sources and no premiums have been/
will be paid out of proceeds of crime related to any of the
offence listed in Prevention of MoneyLaundering Act,2002. I
understand that the Company has the right to call for
documents to establish sources of funds. The insurance
company has right to cancel the insurance contract in case
I am/have been found guilty by any competent court of law
under any of the statutes, directly or indirectly governing
the prevention of money laundering in India.
UIN No.: NAVHLIP22133V012122
IRDAI Registration Number: 155

GSTIN: 29AAFCD7985H1Z0
CIN: U66000KA2016PLC148551
Registered & Corporate Office: NAVI GENERAL
INSURANCE LIMITED, AMR Tech Park, Ground Floor, No 23
& 24, Hosur Road, Bommanahalli, Bangalore- 560068
Policy Servicing Office : NAVI GENERAL INSURANCE
LIMITED, AMR Tech Park, Ground Floor, No. 23 & 24 Hosur
Road, Bommanahalli, Bangalore Karnataka 560068 India
Toll-Free No: +91 81475 44555
Web: www.naviinsurance.com
Email: [email protected]
Navi Health(by Navi General Insurance) is the Trademark
used by Navi General Insurance Ltd. for its digital
platform.

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Navi Health Insurance Policy

Policyholder Name DATTAM VENKATESWARLU

Policy Issued On 25/03/2023

Policy Valid Upto 24/03/2024

Insurance Agent/Intermediary Details

Name Direct Digital

Contact No. +91 81475 44555

Member ID: SA006T0V-01

Insured Person Name DATTAM VENKATESWARLU

Relation with Policyholder Self

Date of Birth (DD/MM/YYYY) 12/02/1992

First Enrolment Date 25/03/2023

Waiting Periods 0 - 10L

Pre Existing Disease 12 MONTH

30 days waiting period Applicable

Insured Person Details

Member ID: SA006T0V-02

Insured Person Name CHINTHALA VANI

Relation with Policyholder Spouse

Date of Birth (DD/MM/YYYY) 10/06/1995

First Enrolment Date 25/03/2023

Waiting Periods 0 - 10L

Pre Existing Disease 12 MONTH

Specific Disease/ Procedure 12 MONTH

Maternity Benefit Waiting period

Total Premium ₹ 8,551.34

GST @ 18% ₹ 1,539.24

Total Amount (inlc GST) ₹ 10,090.58

This is to certify that DATTAM VENKATESWARLU

Monthly Instalment amount 840.88

Monthly instalment due date 25th of every month

First instalment paid date 25/03/2023

Last instalment due date 25/02/2024

For the purpose of deduction under section 80 D

Type Family Floater

Base Medical Cover Amount ₹ 1000000

Medical Cover Amount (Base + Cumulative

Up to 100% of medical cover

Wellness Benefits Covered

Post-Hospitalisation 180 Days

Up to 100% of medical cover

Air Ambulance Covered upto 5 lakhs

Home Hospitalisation Cover

Up to 100% of medical cover

Non payable expenses

Up to 100% of medical cover

Organ Donor Expenses

Up to 100% of medical cover

Additional Medical Cover Amount for Accidental

Up to 100% of medical cover

Newborn Baby Cover Up to ₹ 10,000

Maternity Cover Up to ₹ 30,000

Name Navi General Insurance Limited

Date of Signature of Proposal 24/03/2023

Place of Supply Bangalore

The Stamp Duty of Rs. 0.50 paid vide defaced no.

Navi General Insurance Limited

Policy Servicing Office :NAVI GENERAL

Document Digitally Signed

TPA Name Navi Health Insurance claims

Toll Free Number 8147544555

Navi General Insurance Limited Registered &

This Insurance policy has been issued on the basis