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Terms & Conditions forming part of this Policy No. 71250034182100000017 may be downloaded from our website,
newindia.co.in/citibank.
Signature Not
Verified
Digitally signed
by Srinivasan Document generated by null at 05/12/2018 05:00:12 Hours.
Vaideswaran Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Date: 2018.12.05
For 05:01:31
redressal of your grievance, if any,you may approach any one of the following offices- 1. Policy issuing office 2. Regional office 3. Head office.In case, you are not satisfied with
IST
our own grievance redressal mechanism; you may also approach Insurance Ombudsman. For details of our office addresses and addresses of office of Insurance Ombudsman, please
visit our website http://newindia.co.in.
THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)
This certificate is issued based on the application made by the Citibank Card Members / Account Holders in writing / over
internet / Phone in respect of self and/or family members and/or domestic employess such application shall be the basis of
this Contract of Insurance Coverage.
The benefits in respect of the within mentioned insured persons are subject to definitions,terms,conditions and exclusions
under the respective policies.
This policy is subject to Good Health Policy Clause GH 2013-OCT.
Address of the Policy Divisional Office : 712500 In witness whereof the undersinged being duly authorised
issuing Office II Floor, Mount Casa Blanca Building, by the Insurers and on behalf of the Insurers has (have)
No.260, Anna Salai,Chennai-600006 hereunder set his (their)hand(s) on this 01st day of December
2018.
Phone Numbers 044-23456824 /826 / 827
Fax 044-23456825
Email Id nia.gh712500@newindia.co.in
Website newindia.co.in/citibank
M.V. CHANDRASEKAR
Senior Divisional Manager
This is to certify that Mr./Mrs. SRIRAMA MURTHY IPPILI has paid ` 33110 (Rupees Thirty-Three
Thousand One Hundred Ten Only) towards premium for Mediclaim Insurance GH DEC2018 4138
for the period 01/12/2018 to 30/11/2019.
(You are not eligible to claim Income Tax Deduction in the event of Cancellation of this
Certificate).
M.V. CHANDRASEKAR
Senior Divisional Manager
IMPORTANT
This policy is subject to the terms and conditions contained in the policy document (Clauses).
This policy is governed by Health Insurance Regulations 2016 issued by Insurance Regulatory
Development Authority of India on 12.07.2016.
This policy is also governed by IRDAI (Protection of Policyholders' Interest) Regulations, 2017.
This Schedule comes attached with the policy document (Clauses). If not attached, please ask for the
same.
Health Insurance Regulations 2016 and IRDAI (Protection of Policyholders' Interest) Regulations, 2017 are
available on the website of IRDAI.