GROUP PERSONAL ACCIDENT INSURANCE POLICY

Certificate of Insurance
Policyholder ID: C000033719 Master Policy No: 27100000001
Mr. Dinesh Singh Certificate No: 016586
House No 443, Ews Neem Sarai, Policy Period: From 10:00 on 31/01/2018 To
Allahabad, Uttar Pradesh, midnight of 30/01/2023
Nr St Vishna School,, Allahabad Policy Type: Individual
Allahabad-211011 UIN of the Product: DHFPAGP18028V011718
Allahabad - Uttar Pradesh
Mobile No: 7525001560

Insurance Agent/Intermediary Details

Insurance Agent/Intermediary Code P020001000

Insurance Agent/Intermediary Name M/s Dewan Housing Finance Corporation Ltd
Insurance Agent/Intermediary Contact No. 180030001919

Insured Person’s Details

Member ID Insured Person Name Relationship to Primary Insured Sum Insured

42652/01 Mr. Dinesh Singh Self ` 1,600,000.00

Member ID Date of Birth Age Nominee Name Assignee Name

42652/01 20/01/1984 34 Sumitra SINGH DHFL

Net Premium ` 4,320.40

IGST @ 18% ` 777.60

Total Premium ` 5,098.00

This certificate is subject to master policy terms & conditions issued to M/s Dewan Housing Finance Corporation Ltd

Place: Mumbai For & on behalf of DHFL General Insurance Ltd.

Date: 01/02/2018

Authorized Signatory

Policy Service Office 2nd Floor, DHFL House, 19, Sahar Road, Off Western Express Highway, Vile Parle (East), Mumbai
Mumbai Maharashtra 400099
Stamp Duty The Stamp Duty of ` 80.00 paid vide defaced no: 0002942153201718 dated: 11/09/2017
GST Details
Customer GSTIN Number HSN Number 9971
Place of Supply Allahabad State Code UP00

IRDAI Registration Number: 155 CIN: U66000MH2016PLC283275 GSTIN: 27AAFCD7985H1Z4 Page 1

Note
1. Any GST charged on the said premium will be refunded in accordance with the GST provisions as applicable on the said date. Further,
wherever the GST amount is refunded for which input tax credit was availed by the Customer, the same shall be reversed by the
Customer on receipt of the Credit Note. In case the tax deduction entitled to DHFL-GI on account of such refund is disallowed due to
non-reversal of input tax credit by the customer, the said tax portion should be separately recoverable (along with interest) from the
Customer. Premium refund requests received after September following the financial year in which the policy was issued will be
processed exclusive of GST.
2. This document qualifies as a tax invoice for the purpose of the GST Legislation.
3. Whether GST payable under reverse charge basis: No.

Important Note
This Certificate, Policy terms and conditions and Endorsement shall be read together and word or expression to which a specific meaning
has been attached in any part of this Policy or of the Schedule shall bear the same meaning wherever it may appear. Any
amendments/modifications/alterations made on this system generated policy document is not valid and Company shall not be liable for
any liability whatsoever arising from such changes. Any changes required to be made in the policy once issued, would be valid and
effective, only after written request is made to the Company and Company accepts the requested amendments/modifications/alterations
and records the same through separate endorsement to be issued by the Company. Our grievance redressal procedure and details about
ombudsman is also available in our policy wording. Please note that any misrepresentation, non-disclosure or withholding of material facts
will lead to cancellation of policy ab-initio with forfeiture of premium and non-consideration of claim, if any.

Coverage Details

Coverage Sum Insured & Limits

 Accidental Death ` 1,600,000.00

 Accidental Permanent Total Disability ` 1,600,000.00

 Child Tuition Benefit ` 20,000.00

Claim Payout Option: 100% Lumpsum

Claim Procedure

1. Notify the claim to Us either at Call Centre toll free no. 1800 123 0004 or in email within 7 days of claim occurrence at
mycare@dhflinsurance.com
2. Submit the documents within 30 days of date of occurrence of an accident.
3. Documents to be submitted are - (1) Duly filled & signed claim form (2) Copy of FIR/ Panchnama /Police Inquest Report (if conducted)
(3) Copy of Death Certificate (4) Copy of Post Mortem, if conducted (5) Disability Certificate (6) Any other document as requested by
Claims official.
4. Claim shall be settled/rejected within 30 days of the receipt of the last “necessary” documents or 45 days in case where We have
initiated investigation.
5. In case of delay in the payment beyond the stipulated timelines, We shall be liable to pay interest at a rate of two percent (2%) above
the Bank Rate from the receipt of the last relevant document from the insured /claimant by insurer till the date of actual payment.

Important Exclusions/Conditions

1. We will not make any payment under this policy howsoever attributable to -
• any Pre-existing Condition(s) / disability, any complication arising from it
• suicide or attempted suicide, intentionally self inflicted Injury or Illness, acts of self-destruction whether the Insured Person is
medically sane or insane
• being under the influence of drugs, alcohol, or other intoxicants or hallucinogens
• participation in an actual or attempted felony, riot, crime, misdemeanor, or civil commotion
• ionizing radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from burning nuclear fuel.
2. The Certificate of Insurance shall be void and all premium paid shall be forfeited to Us, in the event of misrepresentation, mis-
description or non-disclosure of any material fact, fraud or non cooperation of the insured.
3. The Certificate of insurance is renewable subject to the renewal premium being paid and the Group Policy is in force, on or before the
renewal due date. On renewal the benefits provided under the policy and/or terms and conditions of the policy including premium rate
may be subject to change. Grace period of 30 days is allowed for renewal of the policy.
4. The insured covered under this Group Personal Accident Insurance Policy can opt to migrate to a suitable Individual Personal Accident
Policy offered by Us. The member shall apply for portability at least 45 days before the premium renewal date.
5. Product will be withdrawn after approval from IRDAI. In such a case, we will inform the Group Organiser/ Administrator.

For policies which fall due for renewal within 15 days from the date of withdrawal – There will be one time option for the Group
Administrator to renew the existing policy with Us or migrate to modified or new similar health insurance policy with Us.

IRDAI Registration Number: 155 CIN: U66000MH2016PLC283275 GSTIN: 27AAFCD7985H1Z4 Page 2

 For policies which fall due for renewal after fifteen (15) days from the date of withdrawal – The only option will be to migrate to modified
or new similar health insurance policy with Us.

You will have an option to opt for similar health insurance policy with Us subject to Portability norms in vogue.

6. You may request to cancel this Certificate of Insurance by sending 15 days notice in writing to Us. We shall refund the amount post
retention of the premium (as per the short period table) for the period the policy has been in force. However, in case of claim in the
policy, there will be no refund of premium.

IRDAI Registration Number: 155 CIN: U66000MH2016PLC283275 GSTIN: 27AAFCD7985H1Z4 Page 3