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Office code 171200 Policy Type GRO

Policy Yr/No.: 2011 248 Previous Policy Yr/NoBroker Code LC0000000179 Endt. Effectv. From :

Name R Gnaneswaran

SAP ID 20022695 Policy IssuingOffice

Service Tax No.

OIC 100% NII 0% UI

Sr. No. Name of the Insured person/s Date of Birth Age (Yrs.) Relationsh1 R Gnaneswaran 18-Jun-75 3

2 G. Subadhra 24-Feb-82

3 G. Ashwanth Sai Ram 7-Aug-09

4

567

TOTAL NO. OF PERSONS : Self + Spouse + 1 Child

TOTAL NO.OF PERSONS 3

In case of any Claim/query please contact TPA ……. M/S

This certificate is issued based on the application made by the Aegis Employee either in writing or over the phone, in respect of self and/ such application shall be the basis of this Contract of Insurance coverage. The benefits in respect of the within insured persons are subjecmentioned under the respective policies.

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UNI /2532-Nov-2010RS.2,698

ICY PERIOD

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