Vehicle Details Policy Details Make MARUTI Policy No. 2302 2055 0795 7503 000 Model OMNI-E MPI STD Period of Insurance From 25 Jun, 2026 00:01 hrs Registration No WB-64-S-7574 To 24 Jun, 2027 23:59 RTO COOCH BEHAR Issuance Date 24/06/2026 Chassis No. MA3EVB11S01848805 Invoice No. 205507957503000 Cubic Capacity /Watts 796 Seats 8 Customer Id 102090987828 Year of Manufacture 2018 Body Type MINIVAN PAN/Form 97 ID FDZPS3704Q Engine No. F8BIN5072263 EIA No. Not provided Odometer reading: Payment Details : PMR27011743241847 , Bank Name:BIZDIRECT Email ID : aexxxxxxxxxxxna@gxxxx.com MR SANJIB SARKAR Communication Address: UTTAR GHOGAR KUTHI UTTAR GHOGAR KUTHI GHOGARKUTHI PRATHAM KHANDA GHOGARKUTHI KOCH BIHAR WEST BENGAL COOCH BEHAR COOCH BEHAR WEST BENGAL - 736159 Tel. 97XXXXXXX0 Policy Year Policy Period For the Vehicle (`) Trailer (`) Non Electrical Acc. (`) Electrical Acc. (`) CNG/LPG Kit (`) Total IDV (`) Year 1 From 25/06/2026 To 24/06/2027 175000 0 0 0 0 175000 Bundled cover Liability only Cover From Date & Time 25/06/2026 00:01 hrs To Date & Time 24/06/2027 Midnight From Date & Time 25/06/2026 00:01 hrs To Date & Time 24/06/2027 Midnight Note: Bundled policy wordings and Liability only policy wording will be applicable for the respective policy durations mentioned above Premium Details Own Damage Premium(a) (`) Liability Premium(b) (`) Basic Own Damage 3518 Basic Third Party Liability 2094 Total Basic Premium 3518 LL to Paid Driver (IMT-28) 50 Less: No Claim Bonus (45%) 1583 PA Cover for Un-Named Persons of 40000 Each (for 8 Persons) (IMT-16) 160 Total - Less 1583 Net Liability Premium (b) 2304 Total Package Premium (a+b) 4239 GST 18% : Central Tax 9% ( `381.5 ) + State Tax 9% ( `381.5) 763 Net Own Damage Premium (a) 1935 Total Premium 5002 (`) Geographical Area India Compulsory Deductible (IMT-22) 1,000 Voluntary Deductible 0 Previous Policy No. 2302205507957502000 Valid 25/06/2025 to 24/06/2026 of HDFC ERGO GENERAL INSURANCE CO.LTD. NCB 35% Policy Holder declare that no claim has been made in the previous year policy. If declaration found incorrect, benefits under the present policy in respect of own damage section will stand forfeited. Compulsory PA cover for owner driver has not been provided to the insured basis his/her declaration of not holding an effective driving license Or having Alternate PA / Stand alone CPA policy with minimum sum insured of Rs 15 Lakhs. Leased Agreement (IMT-6)/Hypothecated (IMT-7) with LIMITATIONS AS TO USE: The Policy covers use of the vehicle for any purpose other than: a) Hire or Reward b) Carriage of goods (other than samples or personal luggage) c) Organized racing d) Pace making e ) Speed testing f) Reliability Trials g ) Any purpose in connection with Motor Trade. Persons or Class of Persons entitled to drive: Any person including the insured, provided that a person driving holds an effective driving license at the time of the accident and is not disqualified from holding or obtaining such a license. Provided also that the person holding an effective learner's license may also drive the vehicle and that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989. Limits of Liability 1. Under Section II-1 (i) of the policy - Death of or bodily injury - Such amount as is necessary to meet the requirements of the Motor Vehicles Act, 1988. 2. Under Section II - 1(ii) of the policy -Damage to Third Party Property- ` 750000 3. P. A. Cover under Section III for Owner - Driver(CSI): ` NA Terms, Conditions & Exclusions: As per the Indian Motor Tariff. A personal copy of the same is available free of cost on request and the same is also available at our website. I / We hereby certify that the policy to which the certificate relates as well as the certificate of insurance are issued in accordance with the provision of chapter X, XI of M. V.Act 1988.The stamp duty of Rs. 0.5/- paid vide Order No:(LOA/ENF-1/CSD/62/2025/ Validity Period Dt. 06/06/2025 to Dt. 31/12/2030, OW No. 2190 Dt 06/06/2025 GRN NO. MH001421282202526M, Dt. 03/05/2025 & DEFACE No. 0001684540202526 Dt. 28/05/2025) a s prescribed b y Government of Maharashtra Notification No. Mudrank 2017/C.R.97/M-1, Dt.09/01/2018. I / We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the aggregate turnover notified under sub-rule (4) of rule 48, we are not required to prepare an invoice in terms of the provisions of the said sub-rule. IMPORTANT NOTICE: The Insured i s not indemnified if the vehicle i s used o r driven otherwise than in accordance with this Schedule. Any payment made by the Company by reason of wider terms appearing in the Certificate in order to comply with the Motor Vehicle Act, 1988 i s recoverable from the Insured. See the clause headed "AVOIDANCE OF CERTAIN TERMS AND RIGHT OF RECOVERY". Disclaimer: The Policy shall be void from inception if the premium in full i s not realised by the company. In the event of m
"For detailed policy terms and conditions please visit our website https://www.hdfcergo.com/download/policy-wordings HDFC ERGO General Insurance Company Limited Certificate of Insurance cum Policy Schedule 2302205507957503000 PRIVATE CAR COMPREHENSIVE POLICY 2302205507957503000 HDFC ERGO General Insurance Company Limited.IRDAI Reg No.146.CIN : U66030MH2007PLC177117. Registered & Corporate Office: HDFC ERGO General Insurance Company Limited – 6th Floor, Leela Business Park, Andheri-Kurla Road,Andheri (East),Mumbai – 400 059. UIN :IRDAN125RP0001V02201415. Policy Issuing/ Customer Happiness Center: D 301, 3rd Floor, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078. Customer Service No : 022 6158 2020 / 022 6234 6234 | www.hdfcergo.com
Vehicle Details Proposal Details Make MARUTI Proposal No. 202606240121757 Model OMNI-E MPI STD Period of Insurance From 25 Jun, 2026 00:01 hrs Registration No WB-64-S-7574 To 24 Jun, 2027 23:59 RTO COOCH BEHAR Issuance Date 24 Jun 2026 Chassis No. MA3EVB11S01848805 Invoice No. 205507957503000 Cubic Capacity 796 Seats 8 Customer Id 102090987828 Year of Manufacture 2018 Body Type MINIVAN PAN/Form 97 ID FDZPS3704Q Engine No. F8BIN5072263 Odometer reading: Payment Details : PMR27011743241847 , Bank Name:BIZDIRECT Email ID : aexxxxxxxxxxxna@gxxxx.com 2302205507957503000 MR SANJIB SARKAR UTTAR GHOGAR KUTHI UTTAR GHOGAR KUTHI GHOGARKUTHI PRATHAM KHANDA GHOGARKUTHI KOCH BIHAR WEST BENGAL COOCH BEHAR COOCH BEHAR - 736159 WEST BENGAL - Tel. 97XXXXXXX0 Policy Year Policy Period For the Vehicle (`) Trailer (`) Non Electrical Acc. (`) Electrical Acc. (`) CNG/LPG Kit (`) Total IDV (`) Year 1 From 25/06/2026 To 24/06/2027 175000 0 0 0 0 175000 Own Damage Policy Period Liability Policy Period From Date & Time 25/06/2026 00:01 hrs To Date & Time 24/06/2027 Midnight From Date & Time 25/06/2026 00:01 hrs To Date & Time 24/06/2027 Midnight Note: Bundled policy wordings and Liability only policy wording will be applicable for the respective policy durations mentioned above Premium Details Own Damage Premium(a) (`) Liability Premium(b) (`) Basic Own Damage 3518 Basic Third Party Liability 2094 Total Basic Premium 3518 LL to Paid Driver (IMT-28) 50 Less: No Claim Bonus (45%) 1583 PA Cover for Un-Named Persons of 40000 Each (for 8 Persons) (IMT-16) 160 Total - Less 1583 Net Liability Premium (b) 2304 Total Package Premium (a+b) 4239 GST 18% : Central Tax 9% ( `381.5 ) + State Tax 9% ( `381.5) 763 Net Own Damage Premium (a) 1935 Total Premium 5002 (`) Geographical Area India Compulsory Deductible (IMT-22) 1,000 Voluntary Deductible (IMT-22A) 0 Previous Policy No. 2302205507957502000 Valid 25/06/2025 to 24/06/2026 of HDFC ERGO GENERAL INSURANCE CO.LTD. NCB 35% Policy Holder declare that no claim has been made in the previous year policy. If declaration found incorrect, benefits under the present policy in respect of own damage section will stand forfeited. Compulsory PA cover for owner driver has not been provided to the insured basis his/her declaration of not holding an effective driving license Or having Alternate PA / Stand alone CPA policy with minimum sum insured of Rs 15 Lakhs. Leased Agreement (IMT-6)/Hypothecated (IMT-7) withAgent Name : BIJOY PAUL Agent Code : 200165331586 Tel No. : 91-9832020567 Anti rebate clause Prohibition of Rebates (Section 41 of Insurance Act, 1938 as amended) : 1. No person shall allow o r offer to allow, either directly or indirectly, as an inducement to any person to take out or renew or continue an insurance in respect of any kind of risk relating to lives or property in India, any rebate of the whole or part of the commission payable or any rebate of the premium shown on the policy, nor shall any person taking out or renewing or continuing a policy accept any rebate, except such rebate as may be allowed in accordance with the published prospectuses or tables of the insurer: provided that acceptance by an insurance agent of commission in connection with a policy of life insurance taken out by himself on his own life shall not be deemed to be acceptance of a rebate of premium within the meaning of this sub-section if at the time of such acceptance the insurance agent satisfies the prescribed conditions establishing that he is a bona fide insurance agent employed by the insurer. 2. Any person making default in complying with the provisions of this section shall be liable for a penalty which may extend to ten lakh rupees.. Terms and Conditions I hereby declare that the Insured Person(s) listed in Proposal Form will abide to the following T&C: 1 ) I/We hereby declare that the statements made by me/us are true to the best of my / our knowledge and belief and I/we hereby agree that this declaration shall form the basis of the contract between me/us and HDFC ERGO General Insurance Company Limited. 2) I/We also declare that, if any additions or alterations are carried out after the submission of this proposal form, then the same would be conveyed to the insurers immediately. 3) I/We also shall endeavor to procure the renewal notice and pass on the same to HDFC ERGO General Insurance immediately upon the receipt of such renewal notice. 4 ) Any person who, knowingly and with intent to defraud the Insurance Company o r other persons, files a proposal for insurance containing any false information, o r conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent act which will render the policy voidable at the Company's sole discretion and result in a denial of insurance benefits. GSTIN :- Motor(Comprehensive and TP):For policy issued in the name of corporate entity (proprietor, HUF, partnership, private company etc), GSTIN is printed on the policy, basis th
CUSTOMER INFORMATION SHEET/KNOW YOUR POLICY This document provides only key information about your policy. Please refer to the policy document for detailed terms and conditions. S.No Title Description (Please refer to applicable Policy Clause Number in next column) Policy Clause Number 1 Product Name PRIVATE CAR COMPREHENSIVE POLICY 2 Unique Identification Number (UIN) allotted by IRDAI UIN NO: IRDAN125RP0001V02201415 3 Structure Section I: indemnity basis Section I- Sum Insured – Insured’s Declared Value (Idv) Section II: Legal liability as per M.V act, Workmen compensation act 4 Interests Insured Motor Vehicle 5 Sum Insured / Motor Insured Declared Value Scope Section I: 3518 Refer policy schedule Section II:Unlimited IDV illustration: IDV is calculated basis Manufacturer listed price for Sale - Depreciation of Car which is dependent on vehicle age To view depreciation schedule, please visit; https://www.hdfcergo.com/car-insurance/insured-declared-value-idv Illustration: Manufacturer listed price of vehicle: 20,00,000/- Age of vehicle: 2-3 year Depreciation applicable: 30% IDV applicable 20,00,000 -30%= 14,00,000/- 6 Policy Coverage Covers the Private Cars against: Section I: Loss of or Damage to the Vehicle Insured Section I: Loss of or Damage to the Vehicle Insured The Company will indemnify the insured against loss or damage to the vehicle insured hereunder and/or its accessories whilst thereon i. by fire explosion self ignition or lightning; ii. by burglary housebreaking or theft; iii. by riot and strike; iv. by earthquake (fire and shock damage); v. by flood typhoon hurricane storm tempest inundation cyclone hailstorm frost; vi. by accidental external means; vii. by malicious act; viii. by terrorist activity; ix. whilst in transit by road rail inland- waterway lift elevator or air; x. by landslide rockslide. Section II: Lability to Third Parties Lability to Third Parties Company will indemnify the insured in the event of an accident caused by or arising out of the use of the insured vehicle against all sums which the insured HDFC ERGO General Insurance Company Limited 2302205507957503000 HDFC ERGO General Insurance Company Limited.IRDAI Reg No.146.CIN : U66030MH2007PLC177117. Registered & Corporate Office: HDFC ERGO General Insurance Company Limited – 6th Floor, Leela Business Park, Andheri-Kurla Road,Andheri (East),Mumbai – 400 059. UIN :IRDAN125RP0001V02201415. Policy Issuing/ Customer Happiness Center: D 301, 3rd Floor, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078. Customer Service No : 022 6158 2020 / 022 6234 6234 | www.hdfcergo.com
S.No Title Description (Please refer to applicable Policy Clause Number in next column) Policy Clause Number shall become legally liable to pay in respect of i) death of or bodily injury to any person including occupants carried in the insured vehicle (provided such occupants are not carried for hire or reward) but except so far as it is necessary to meet the requirements of Motor Vehicles Act, the Company shall not be liable where such death or injury arises out of and in the course of the employment of such person by the insured, ii) damage to property other than property belonging to the insured or held in trust or in the custody or control of the insured. HDFC ERGO General Insurance Company Limited 2302205507957503000 HDFC ERGO General Insurance Company Limited.IRDAI Reg No.146.CIN : U66030MH2007PLC177117. Registered & Corporate Office: HDFC ERGO General Insurance Company Limited – 6th Floor, Leela Business Park, Andheri-Kurla Road,Andheri (East),Mumbai – 400 059. UIN :IRDAN125RP0001V02201415. Policy Issuing/ Customer Happiness Center: D 301, 3rd Floor, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078. Customer Service No : 022 6158 2020 / 022 6234 6234 | www.hdfcergo.com
7 Add-on Cover Paid Driver 50,Personal Accident Cover 160 Refer policy schedule 8 Loss Participation Workshop Generates the invoice basis the assessment given by the surveyor. - For Cashless Settlement, Insured pays his share of liability to the Workshop which includes - Compulsary deductible (As per the policy schedule) and Voluntary deductible (IMT22A), if opted as per the chosen slab and takes delivery of the vehicle. - For Reimbursement Settlement, Insured pays the entire invoice amount to Garage Workshop, HDFC ERGO will reimburse its share of liability minus the Compulsary and voluntary deductible(if applicable) to Insured's account. 9 Exclusions The Company shall not be liable under this Policy in respect of: General Exception s Section I: 1. any accidental loss or damage and/or liability caused sustained or incurred outside the geographical area; 2. any claim arising out of any contractual liability; any liability of whatsoever nature directly or indirectly caused by or contributed to by or arising from ionising radiations or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel. For the purpose of this exception combustion shall include any self-sustaining process of nuclear fission 3. any accidental loss or damage or liability directly or indirectly caused by or contributed to by or arising from nuclear weapons material. 4. any accidental loss damage and/or liability directly or indirectly or proximately or remotely occasioned by contributed to by or traceable to or arising out of or in connection with war, invasion, the act of foreign enemies, hostilities or war like operations (whether before or after declaration of war) civil war, mutiny rebellion, military or usurped power or by any direct or indirect consequence of any of the said occurrences and in the event of any claim hereunder the insured shall prove that the accidental loss damage and/or liability arose independently of and was in no way connected with or occasioned by or contributed to by or traceable to any of the said occurrences or any consequences thereof and in default of such proof, the Company shall not be liable to make any payment in respect of such a claim. Section II: 1.any accidental loss damage and/or liability caused sustained or incurred whilst the vehicle insured herein is TP a. being used otherwise than in accordance with the ‘Limitations as to Use’ or b. being driven by or is for the purpose of being driven by him/her in the charge of any person other than a Driver as stated in the Drivers Clause 10 Special Conditions and Warranties (if any) As per policy schedule Refer policy schedule HDFC ERGO General Insurance Company Limited 2302205507957503000 HDFC ERGO General Insurance Company Limited.IRDAI Reg No.146.CIN : U66030MH2007PLC177117. Registered & Corporate Office: HDFC ERGO General Insurance Company Limited – 6th Floor, Leela Business Park, Andheri-Kurla Road,Andheri (East),Mumbai – 400 059. UIN :IRDAN125RP0001V02201415. Policy Issuing/ Customer Happiness Center: D 301, 3rd Floor, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078. Customer Service No : 022 6158 2020 / 022 6234 6234 | www.hdfcergo.com
11 Admissibility of Claim Following are the key parameters leading to admissibility or denial of claims: -Loss will be admissible only if occured from insured perils mentioned in policy wordings. - Report the Loss to Insurance Company without any delay. - Duty of care & loss minimization post accident. - Avoid willful Negligence and self-damage to insured vehicle. - Ensure vehicle is in best running condition - Drive the vehicle responsibly - Not to use the vehicle for any other purposes other than what is the vehicle is registered for. - Take additonal coverage before planning to take vehicle outside the defined geographical areas. Include a sample claim calculation process for retail products 1. Assessed amount by the surveyor is billed in the final invoice. 2. Surveyor processes the bill and calculates the amount payable by Inurance Company (Sample Calculation Sheet) 3. Parts in bills are categorized as per replacement, repair, labour and paint and applicable depreciation as per the Indian Motor Tariff is applied.(Parts Depreciation Sheet) 4. Deductibles as per the policy are deducted from the summary and policy benefit(Zero Depreciation, Consumables, Return to Invoice, etc) is added and final Insurance Company payable is calculated. GENERAL EXCEPTIONS (Applicable to all sections of the Policy) The Company shall not be liable under this Policy in respect of 1. any accidental loss or damage and/or liability caused sustained or incurred outside the geographical area; 2. any claim arising out of any contractual liability; 3. any accidental loss damage and/or liability caused sustained or incurred whilst the vehicle insured herein is a. being used otherwise than in accordance with the ‘ Limitations as to Use’ or b. being driven by or is for the purpose of being driven by him/her in the charge of any person other than a Driver as stated in the Driver's Clause 4. i. any accidental loss or damage to any property whatsoever or any loss or expense whatsoever resulting or arising there from or any consequential loss. ii. any liability of whatsoever nature directly or indirectly caused by or contributed to by or arising from ionising radiations or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel. For the purpose of this exception combustion shall include any self-sustaining process of nuclear fission 6. any accidental loss damage and/or liability directly or indirectly or proximately or remotely occasioned by contributed to by or traceable to or arising out of or in connection with war, invasion, the act of foreign enemies, hostilities or war like operations (whether before or after declaration of war) civil war, mutiny rebellion, military or usurped power or by any direct or indirect consequence of any of the said occurrences and in the event of any claim hereunder the insured shall prove that the accidental loss damage and/or liability arose independently of and was in no way connected with or occasioned by or contributed to by or traceable to any of the said occurrences or any consequences thereof and in default of such proof, the Company shall not be liable to make any payment in respect of such a claim. 12 Policy Servicing - Claim Intimation and Processing 1.Turnaround time for claim settlement including escalation matrix] Input from Claims Team HDFC ERGO General Insurance Company Limited 2302205507957503000 HDFC ERGO General Insurance Company Limited.IRDAI Reg No.146.CIN : U66030MH2007PLC177117. Registered & Corporate Office: HDFC ERGO General Insurance Company Limited – 6th Floor, Leela Business Park, Andheri-Kurla Road,Andheri (East),Mumbai – 400 059. UIN :IRDAN125RP0001V02201415. Policy Issuing/ Customer Happiness Center: D 301, 3rd Floor, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078. Customer Service No : 022 6158 2020 / 022 6234 6234 | www.hdfcergo.com
As per PPHI guidelines on our website https://www.hdfcergo.com/docs/default-source/policies/pphi-policy.pdf 2. a) Surveyor appointment- 24 hours Pendency letters- 7 days Interim survey report- 15 days Final survey report- 30 days Additional survey report- 15 days Settlement post survey report- 30 days b) Customer Escalation Matrix Level 1 In case the Complainant has not received a response or is not satisfied with the response / resolution given / offered, then the Customer can write to: The Complaints & Grievance Cell HDFC ERGO General Insurance Company Limited D-301, 3rd Floor, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai – 400078, Maharashtra e-mail: grievance@hdfcergo.com • Level 2 In case the Complainant has not received a response or is not satisfied with the response / resolution given / offered by the C&G cell, then the Customer can write to the Chief Grievance Officer of the Company at the following address The Chief Grievance Officer HDFC ERGO General Insurance Company Limited D-301, 3rd Floor, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai – 400078, Maharashtra e-mail: cgo@hdfcergo.com • Level 3 Office of The Insurance Ombudsman 13 Grievance Redressal and Policyholders Protection If You have a grievance about any matter relating to the Policy, or Our decision on any matter, or the claim, You can address Your grievance as follows: Grievanc e Redress al 1. Our Grievance Redressal Officer If you have a grievance that you wish us to redress, you may contact us with the details of your grievance through: • Call Centre - 022 6158 2020 / 022 6234 6234 • Emails – grievance@hdfcergo.com • Contact Details for Senior Citizens: 022 6158 2026 | Email ID: seniorcitizen@hdfcergo.com Designated Grievance Officer in each branch. • Company Website – www.hdfcergo.com • Courier - Any of our Branch office or corporate office You may also approach the Complaint & Grievance (C&G) Redressal Cell at any of our branches with the details of your grievance during our working hours from Monday to Friday. If you are not satisfied with our redressal of your grievance through one of the above methods, you may contact our Head of Customer Service at The Complaint & Grievance Redressal Cell , HDFC ERGO General Insurance The Company Ltd. D-301,3rd Floor, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai – 400078, Maharashtra In case you are not satisfied with the response / resolution given / offered by the C&G cell, then you can write to the Chief Grievance Officer of the Company at the following address To the Chief Grievance Officer HDFC ERGO General Insurance The Company Limited D-301, 3rd Floor, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400078, Maharashtra e-mail: cgo@hdfcergo.com HDFC ERGO General Insurance The Company Limited HDFC ERGO General Insurance Company Limited 2302205507957503000 HDFC ERGO General Insurance Company Limited.IRDAI Reg No.146.CIN : U66030MH2007PLC177117. Registered & Corporate Office: HDFC ERGO General Insurance Company Limited – 6th Floor, Leela Business Park, Andheri-Kurla Road,Andheri (East),Mumbai – 400 059. UIN :IRDAN125RP0001V02201415. Policy Issuing/ Customer Happiness Center: D 301, 3rd Floor, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078. Customer Service No : 022 6158 2020 / 022 6234 6234 | www.hdfcergo.com
Grievance may also be lodged at IRDAI Integrated Grievance Management System- https://bimabharosa.irdai.gov.in You may also approach the nearest Insurance Ombudsman for resolution, if your grievance is not redressed by the Company. The contact details of Ombudsman offices are below if your grievance pertains to: • Insurance claim that has been rejected or dispute of a claim on legal construction of the policy • Delay in settlement of claim • Dispute with regard to premium • Non-receipt of your insurance document You may also refer Our website www.hdfcergo.com www.hdfcergo.com/customer-care/grievances.html for detailed grievance redressal procedure. 14 Obligations of the Policyholder • To disclose all information correctly sought by the insurer at time of filling the proposal form • In case of any change / modification / addition to the already declared information the same shall be brought to the notice of the Insurer immediately • Disclosure of material information may affect the claim settlement. Declaration by the Policyholder; I have read the above and confirm having noted the details. Place: Date: (Signature of the Policyholder) Note: i. Insurer shall provide web-link where the product related documents including the Customer Information sheet are available on the w ii. In case of any conflict, the terms and conditions mentioned in the policy document shall prevail. iii. Insurer to take confirmation of the Policyholder regarding receiving of the Customer Information Sheet. HDFC ERGO General Insurance Company Limited 2302205507957503000 HDFC ERGO General Insurance Company Limited.IRDAI Reg No.146.CIN : U66030MH2007PLC177117. Registered & Corporate Office: HDFC ERGO General Insurance Company Limited – 6th Floor, Leela Business Park, Andheri-Kurla Road,Andheri (East),Mumbai – 400 059. UIN :IRDAN125RP0001V02201415. Policy Issuing/ Customer Happiness Center: D 301, 3rd Floor, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078. Customer Service No : 022 6158 2020 / 022 6234 6234 | www.hdfcergo.com