Premium Certificate For the purpose of deduction under section 80D of Income Tax amendment act, 1961 and any amendments made thereafter.
To, CHAKALA ANJANEYULU 12-1-717 Ashok Nagar ANANTAPUR ANDHRA PRADESH 515001 This is to certify that the company company has received a premium of Rs. 6 740 for health insurance coverage coverage under the health policy no. 4034i/ 4034i/FPP FPP/W/W-873 873241 2417/0 7/00/0 0/000 00 vide vide EMI EMI dated dated 02-201 -201 . The product is eligible for deduction u/s 80D of the Income Tax Act, 1961 and any amendments made there to. For ICICI Lombard General Insurance Company
Authorized Signatory
Note:
This certificate must be surrendered to the Insurance Company in case of Cancellation of t he policy. In the event of incorrect representation of this declaration, the liability shall be upon the policyholder. For the purpose of deduction under section 80D, the benefit shall be as per the provisions of the Income Tax Act, 1961 and any amendments made thereafter.
Claim Procedure Before going to the hospital please call ICICI Lombard Health Care Services for complete assistance & guidance ICICI Lombard Health Care Services Number Toll Free Phone Number 1800 2666(Accessible even from your Mobile Phone) Toll Free Fax Number 1800 208 8880 Email:
[email protected] [email protected] Web Site: http://www.icicilombard.com http://www.icicilombard.com Emergency or planned hospitalization : Simply use our Health ID card at our Health Care network hospitals (Refer www.icicilombard.com www.icicilombard.com for updated list) and avail of cashless service.Call our Health Cares 24 hour-toll-free number 1800 2666for claims registration. Treatment in non-network hospitals : The claim form (available at www.icicilombard.com) must be filled fully after discharge from hospital and sent to ICICI Lombard Health Care office along with the original documents.
Claim form duly filled & signed by the insured. Original discharge card & Final bill. All investigation reports in originals. All medicines /lab/ hospital bill in original. All payments receipts in original. Any other required documents depending upon the case.
Note:Please refer to the policy wordings for complete information on Coverage & Exclusions.
For more information on our p roduct, Log on to www.icicilombard.com
E-Mail ID :
[email protected] [email protected]
