Registered Office: Reliance Centre, 19, Walchand Hirachand Marg,Ballard Estate ,

Mumbai - 400 001

Policy Issuing Office : Reliance General Insurance Co. Ltd.,

570, Naigaum Cross Road,
Next to Royal Industrial Estate,
Policy Servicing Branch Office : Reliance General Insurance Co. Ltd,
Reliance General Insurance Co Ltd 202-21
2nd Floor MERCANTILE HOUSE
Wadala (W), Mumbai 400031
KASTURBA GANDHI MARG New Delhi
New Delhi 110001
Rel i ance Indi vidual Medi cl aim Poli cy Schedul e
Name and Address of the Proposer : NILESH GAWAS
304 PARSHWANATH CHS., PATIL PADA, BADLAPUR
THANE
421503
India
Mobile No: 9867947775
Poli cy Number 1301722811000291
Detai ls of previous pol icy (i n case of renewal)
Previous poli cy No. : 1302712811000291
Date of expiry : 25/12/2013
Sum Insured : As Indicated Below
Period of Insurance : From 00:01 on 25/12/2013 to mid-night on 26/12/2014
Name of Insured Person Gender Date of
Birt h
Relat ionship wi th
the Proposer
Occupat ion Pre-Exi sting
Illness
Sum
Insured (Rs)
Domi cil iary
Hospital isati on
Limit (Rs)
Amount
of CB
(Rs)
Loading
(%)
Premium
(Rs)
NILESH GAWAS
APARNA GAWAS
Male
Female
02/10/1981
31/03/1981
Self
Spouse
Others
Others
50000.00 500000.00 555000.00 0 18110.00
* Where an Insured Person is added to this Policy, either by way of endorsement
or at the time of renewal, the pre-existing disease clause,first year exclusion
and 30 days
waiting period is applicable considering such policy period as the first policy
with us.
* Policy would be considered as a fresh policy if there would be break of fiftee
n or more days between the prevoius policy expiry date and current policy start
date.
* Any enhanced Sum insured during subsequent policy renewals will not be availab
le for an illness, diseases, injury already contracted under the preceding polic
y periods.All
Waiting periods as defined in the policy shall apply for this enhanced limit fro
m the effective date of enhancement of such Sum Insured.
* This Insurance is subject to the terms and conditions of policy attached .The
policy wordings with detailed terms , conditions and exclusions is available on
our
website www.reliancegeneral.co.in
Special Conditions, if any :

Premium Detai ls Amount (Rs.)

Gross Premium 18,110.00
Service Tax (12% of Net Premium) 2173.20
Education Cess (2% of Service Tax) 43.46
Secondary and Higher Education Cess (1% of Service Tax) 21.73
Total Premium 20,348.00
(Service Tax Registrati on No: AABCR6747BST001)
Consolidated Stamp duty Paid vide Receipt No.20984 dated 20/12/2013 **
** Not applicable for the State of J ammu and Kashmir
Note: In the event of dishonor of cheque, this policy document automatically sta
nds cancelled from inception, irrespective of whether a separate communication i
s sent or
not.
In witness whereof this policy has been signed at Mumbai on 27/12/2013
For any assistance with claims, please contact us on 1 800 3002 8282 (toll free)
and 3989 8282 (local charges apply) or email us at services.rgicl@relianceada.c
om
TPA/Service Provider Detai ls
TPA/Service Provider Name Paramount Health Services Pvt. Ltd.

Address Please Log on to www.paramounttpa.com for locating the nearest office f

or submission of claim documents
24X7 Cust omer Helpline Number 022-66620880/ (022) 6662 0880(TollFree)
Fax Number (022) 2825 9543 /9743
Email i d contact.phs@paramounttpa.com ( For Insured
Grievances & for any other queries)
Premi um Certi fi cate
Premium Certifi cat e f or the purpose of deduction under Sect ion 80-(D) of In
come Tax (Amendment ) Act 1986.
This is to certify that NILESH GAWAS has paid Rs. 20348 (TWENTY THOUSAND THREE H
UNDRED FOURTY EIGHT) towards premium for Health Insurance for the
Period From 00:01 on 25/12/2013 to Midnight of 26/12/2014 on Dec 17 2013
Poli cy Number : 1301722811000291
Date : 17/12/2013 Pl ace : Mumbai
Note: This certificate must be surrendered to the Insurance Company for issuance
of fresh certificate in case of cancellation of policy or any alteration in the
insurance
affecting the premium.