Relax. We’ve got you covered.

Mr. Shivam Gupta

96/94
Old Ganesh Ganj
Lucknow 226018, Uttar Pradesh
Contact: +91 8858304818

Dear Shivam,

A warm welcome from all of us.

You’ve made a great choice by selecting Corona Rakshak Policy, Edelweiss General Insurance
Company Limited. Your Policy No. is 900106570.

We’re going to do our best to provide you amazing service at all times. Count on us to always give you
the full picture, and to be completely fair and honest.

After reading this letter, do take a little time to download and go through the relevant policy information
on our website www.edelweissinsurance.com. It will help you know all the important details of the cover
you now enjoy. We know that insurance documents can make simple things sound difficult, but we really
think you should read them, because this is important!

The above information bears the main features and benefits, of course, and just as importantly, the
features which are not covered under your policy.

You can download the relevant policy information by following the steps given below:
· Visit www.edelweissinsurance.com
· Visit product page
· Select the desired product
· Download the relevant policy information

We’re just a call or an email away if you need to ask us something.

Write to us at [email protected] or call us at 1800 12000.
Once again, we’re delighted to have you with us.

Warm regards,

Shubhdarshini Ghosh
Executive Director & CEO

Edelweiss General Insurance Company Limited, Corporate Office: 5th Floor, Tower 3, Kohinoor City Mall,Kohinoor City, Kirol Road, Kurla (West), Mumbai -
400070, Registered Office: Edelweiss House, Off CST Road, Kalina, Mumbai -400 098, IRDAI Regn. No.: 159. CIN: U66000MH2016PLC273758 Reach us
on: 1800 12000,Email: [email protected], Website: www.edelweissinsurance.com, Issuing/Corporate Office: +91 22 4272 2200, Grievance
Redressal Officer: +91 22 4931 4422, Dedicated Toll-Free Number for Grievance: 1800 120 216216. Trade logo displayed above belongs to Edelweiss
Financial Services Limited and is used by Edelweiss General Insurance Company Limited under license.

15
Corona Rakshak Policy, Edelweiss General Insurance Company Limited | UIN: EDLHLIP21110V012021
 We know you’re taking
every precaution.
But when precautions don’t work,
you can still count on us.

Corona Rakshak Policy,

Edelweiss General Insurance Company Limited
Policy Schedule
Welcome to your policy. Before you check the details below, we just want you to know that you can
#TakeUsForGranted to be there for you, no matter what. And yes, do save this policy to your phone,
so you don’t have to go searching if you need it.

Proposer Details
Welcome to the Edelweiss General Insurance family!
Name: Mr. Shivam Gupta Client ID: 1000324132
Date of Birth:13-Sep-1991 Gender: Male
Address: 96/94, Old Ganesh Ganj, Lucknow 226018, Uttar Pradesh Age: 28
City & Pin Code: Lucknow 226018 Email ID: [email protected]
Contact No.: Landline: NA Mobile: 8858304818
Insured's GST no.: NA

See something wrong? Write to [email protected]

Policy details
Your policy's most important details
Policy No.: 900106570
Proposal No.: 31503962 Policy Sum Insured: 2,50,000.00
Branch Name: DELHI Branch Code: DEL001
Policy Term: 9.5 Months (285 Days)
Policy start Date & Time: 09-Aug-2020 15:34:00 Policy End Date & Time: 20-May-2021 23:59:59
Effective Policy Period: 9.5 Months (285 Days) End of policy period and time: 20-May-2021 23:59:59
End of waiting period and time: 24-Aug-2020
(15 days from policy start date)
23:59:59
Policy Type: [New/Renewal/Ported] New Policy Issue Date: 09-Aug-2020
Cover Type: Individual

Corona Rakshak Policy, Edelweiss General Insurance Company Limited | UIN: EDLHLIP21110V012021 25
 Insured - Personal details
So who's being covered by this policy?
Relationship with Nominee's Nominee's Relationship
Name of Insured Gender Date of Birth
Policyholder Name Date of Birth with Insured
30-
1 Shivam Gupta Male 13-Sep-1991 Self Asha Gupta Mother
May-1957

Insured - Covered details

What exactly each member covered for?
Hospital
Sum Date of Insured with us Pre-existing
Name of Insured Fresh Daily
Insured Inception since Diseases
Cash(Y/N)
1 Shivam Gupta 2,50,000.00 New 09-Aug-2020 No 09-Aug-2020 No

Name of Insured Specific Exclusions

NA NA

Your Intermediary,
who's looking out for you!
Intermediary Name: Edelweiss Broking Limited
Intermediary Reference Code: 2210000455 Contact: 4049059999

Schedule of benefits
The many benefits of your policy

Sr. Benefit Basis of Offering

1 Covid-19 Cover You'll get 100% of the Sum Insured on positive diagnosis for Novel Coronavirus (nCoV)
(Covid-19) for which you need to be hospitalised for a minimum period of 72 hours. Don't
forget, the positive diagnosis should be from a Government-authorised testing facility

Premium Details
How have we worked out your premium?
Base Premium Excluding Tax (`) 1,056.00
Loadings (`) 0.00
Discounts
Online Discount (0.00%) (`) 0.00
Edelweiss Group Employee Discount (0.00%) (`) 0.00
Family Discount (0.00%) (`) 0.00
Health Care Worker Discount (0.00%) (`) 0.00 IGST/UGST Amount @ 18% ( `) 190.08
Police Personnel Discount (0.00%) (`) 0.00 SGST Amount @ 9% (`) 0.00
Total Discount (`) 0.00 CGST Amount @ 9% (`) 0.00
Total Premium Amount (`) 1,246.08

Corona Rakshak Policy, Edelweiss General Insurance Company Limited | UIN: EDLHLIP21110V012021 35
Received premium payment of `1,246.08 Vide instrument / reference number SHMP9095179347 Dated 09-Aug-2020
against receipt number PP225758

GST Registration Number: 07AAECE2328J1ZQ

Stamp Duty: Consolidated Stamp duty Paid vide Letter of Authorisation No.CSD/314/2020/672/2020 dated
13-02-2020 at General Stamp Office, Mumbai.

Tax is not payable under reverse charge by the recipient

HSN/SAC Code: 9971 Description of Good or Service: General Insurance Service
Place of Supply
State: Uttar Pradesh Code: 09

Contact details for claims Services

Need to claim? Get in touch with our TPA!
TPA Name Paramount Health Services & Insurance TPA Pvt. Ltd.
TPA Address Plot No A-442,Road No 28, Wagle Estate, Ram Nagar, Thane West, Pin Code – 400604
TPA Email ID [email protected]
TPA Website www.paramounttpa.com

Contact Details for Policy Services

Need help with your policy? We're here for you!

NA

Endorsement details (if any)

NA

Attachments:
1) Policy Wording 2) Customer Information Sheet
Please ensure that these documents have been received, read and understood.
Please note:
1. We've issued this Policy with the information we’ve received from you in the Proposal Form. In case we've got it
wrong, please let us know within 15 days of your Policy's receipt date. If we don't hear from you within stipulated 15
days, the information contained in this Policy Schedule will be taken as correct and complete, and will be the basis for
the contract between you and Edelweiss General Insurance Company Limited, and this will be binding.
2. Please read the terms and conditions in the Policy Wordings carefully to understand what we've mentioned in this
Policy Schedule.
3. In the unlikely event that your premium cheque bounces, this Policy will automatically be cancelled from the policy
inception, whether or not we inform you separately, orally or in writing.
4. This Policy Schedule must, always, be read in conjunction with the Policy Wording.
5. Payment of premium by cash are not eligible for income tax benefits.
6. Please return this document to us in case of cancellation of the policy, or if there's a change and we need to give you
a fresh one.

Disclaimer: The information contained above is indicative in nature. For the complete terms and conditions, please
read the Policy Wording as reproduced in our website i.e. at www.edelweissinsurance.com

Corona Rakshak Policy, Edelweiss General Insurance Company Limited | UIN: EDLHLIP21110V012021 45
For Edelweiss General Insurance Company Limited

Signature Not Verified

Digitally signed by DS EDELWEISS GENERAL INSURANCE COMPANY LIMITED
Date: 2020.08.09 16:18:11 IST
Reason: Authentication
Location: Mumbai

Authorized Signatory

Corona Rakshak Policy, Edelweiss General Insurance Company Limited | UIN: EDLHLIP21110V012021 55
 Eligibility of Premium for deduction
under section 80D of Income Tax Act, 1961.

This is to certify that Edelweiss General Insurance Company Limited has received an amount of ` 1,246.08
in Words (One Thousand Two Hundred and Fourty Six Rupees Eight Paise)
from Mr. Shivam Gupta towards payment of health insurance premium as per the details mentioned above.
The premium paid for this Policy is eligible for applicable tax benefits u/s 80D of the Income Tax Act, 1961 and
amendments thereof for the the period from 15:34:00 hrs on 09-Aug-2020 to midnight of 20-May-2021.

For Edelweiss General Insurance Company Limited

Authorized Signatory

Edelweiss General Insurance Company Limited, Corporate Office: 5th Floor, Tower 3, Kohinoor City Mall,Kohinoor City, Kirol Road, Kurla (West), Mumbai -
400070, Registered Office: Edelweiss House, Off CST Road, Kalina, Mumbai -400 098, IRDAI Regn. No.: 159. CIN: U66000MH2016PLC273758 Reach us
on: 1800 12000,Email: [email protected], Website: www.edelweissinsurance.com, Issuing/Corporate Office: +91 22 4272 2200, Grievance
Redressal Officer: +91 22 4931 4422, Dedicated Toll-Free Number for Grievance: 1800 120 216216. Trade logo displayed above belongs to Edelweiss
Financial Services Limited and is used by Edelweiss General Insurance Company Limited under license.

Corona Rakshak Policy, Edelweiss General Insurance Company Limited | UIN: EDLHLIP21110V012021 65