31-25-0408045-00

Devender kumar
HOUSE NO-31 2ND FLOOR,A BLOCK
OPPOSITE HUNDAI SHOWROOM,NIT 5
NA Faridabad
HARYANA
INDIA
121001
7000429412

28/01/2026
Empowering people

Dear Devender kumar,

Thank you for choosing us. In our journey together, we promise to offer you the Up to 100% of your
best insurance and assurance of good health. Premium as Health
ReturnsTM
Together, we will achieve our goals by making every small step count. Every ladder
you climb, every calorie you burn, every lap you swim, every song you dance on -
every little act will move the needle towards a healthier you. 90 days pre and
180 days post
Excited? So are we! Get ready to make the most out of your new insurance plan Hospitalization Coverage
Activ One - MAX

Thank you once again for partnering with us. With our purpose of Empowering You Any Room of your
To Lead A Healthier Life, we ensure you a fruitful and healthful journey. Choice up to
Base Sum Insured
Warm regards,

Claims Protect: Avail

Mayank Bathwal Claim coverage for listed
Chief Executive Officer Non-Medical expenses
Aditya Birla Health Insurance Co. Limited.

Super Reload: Unlimited

refil up to 100% Sum
POLICY NUMBER: 31-25-0408045-00
Insured from 2nd claim
Name Membership No DOB Onwards
Devender kumar PT43356024 15/Jul/1979
NISHA . PT43356028 01/Feb/1985 Introducing The Activ Health
JAI CHANDEL PT43356029 08/Apr/2010
EKLAVYA CHANDEL PT43356030 16/Dec/2022

Your health and your

For assistance, connect with us via the following channels: policy, all in one place

Follow us on: Product Name: Activ One, Product UIN: ADIHLIP24097V012324

 Activ One MAX
Policy Schedule
This document will serve as a quick guide for you to understand important information regarding your health insurance
policy including its key features, coverage limits, premium details and nominee details, among others.

Unit no 1101 & 1104 11th floor, Unit

no 1501& 1502, 15th floor, G Corp
10th Floor, R Tech Park Goregaon
Policy Issuing Office Tech Park, Kasarwadavali, Policy Servicing Office
Mumbai MAHARASHTRA 400063
Ghodbunder Road, Thane
West-400615
POLICYBAZAAR INSURANCE
Intermediary Name Intermediary Code 5100357
BROKERS PRIVATE LIMITED
Intermediary Contact Details 18002585970 Intermediary E-mail ID adityabirla@[Link]
Toll Free Number 18002707000

Policyholder Name Devender kumar

HOUSE NO-31 2ND FLOOR,A BLOCK OPPOSITE HUNDAI SHOWROOM,NIT 5 Faridabad, 121001,
Policyholder Address
Faridabad, HARYANA
Contact Number 7000429412
Email Id dkXXX_7@[Link]
GSTIN NA

Product Name Activ One

Plan MAX
Policy Number 31-25-0408045-00
First Policy Start date 28/01/2026
Start Date of Policy & Time 00:00 hrs on 28/01/2026 Expiry Date & Time of Policy 23:59 hrs on 27/01/2027
Policy Type Family Floater Policy Tenure 1 Year
Enrollment for Automatic renewal
Policy Category Portability NO
premium payment facility
Mode of Premium payment Single
Refer Section V. Previous Insurer
Portability/Migration Yes Previous Policy Number
Details
GSTIN NA GSTIN Account Type NA
Portability

Start date of
Policy of Pre-Existing Start date of
Insured Relationship Age
DOB Diseases first policy with
Name of Insured person Person (only with Member ID (completed Gender
(DD-MM-YYYY) (PED) us(applicable at
in case of new Proposer birthday)
(if applicable) policy renewal)
member
Kidney stone
Devender kumar NA Self PT43356024 46 Male 15/07/1979 28/01/2026
- N202 - 0
NISHA . NA Spouse PT43356028 40 Female 01/02/1985 NA 28/01/2026
JAI CHANDEL NA Son PT43356029 15 Male 08/04/2010 NA 28/01/2026
EKLAVYA CHANDEL NA Son PT43356030 3 Male 16/12/2022 NA 28/01/2026

Continued and to be read in conjunction of the table above

Specific disease Waiting Pre-Existing Disease Super Credit
Base Sum Insured Initial Waiting Period Super Credit %
period Waiting Period Amount
30 Days 2 Years 3 Years 0 NA
30 Days 2 Years 3 Years 0 NA
1000000
30 Days 2 Years 3 Years 0 NA
30 Days 2 Years 3 Years 0 NA
Continued and to be read in conjunction of the table above optional cover opted.
For applicability of Waiting period on Base Sum Insured please refer Section V - Previous policy details

Product Name: Activ One, Product UIN: ADIHLIP24097V012324

0 0
Name of Insured Person Room Rent Type Options
4 0 Devender kumar Single Private Room
NISHA . Single Private Room
0 JAI CHANDEL Single Private Room
EKLAVYA CHANDEL Single Private Room

0 0 Durable Equipment Cover

A combined Sum Insured of INR 5 Lacs or up to Base Sum
0 0 Insured, whichever is lower
A combined Sum Insured of INR 5 Lacs or up to Base Sum
0 4 Insured, whichever is lower
A combined Sum Insured of INR 5 Lacs or up to Base Sum
Insured, whichever is lower
A combined Sum Insured of INR 5 Lacs or up to Base Sum
Insured, whichever is lower

0 40 Second Medical Opinion for 27 listed Major Illnesses

Applicable
Applicable
Applicable
Applicable

Waiting Period from Start Date of Chronic Management Program

Name of the Insured Person Chronic Condition
Start Date of First Policy Coverage Applicability
Devender kumar No NA NA No
NISHA . No NA NA No
JAI CHANDEL No NA NA No
EKLAVYA CHANDEL No NA NA No

Name of the Insured Person Special Condition (if applicable)

Devender kumar No
NISHA . No
JAI CHANDEL No
EKLAVYA CHANDEL No

Name of the Insured Person Pre-Existing Disease Details (if applicable)

Devender kumar Kidney stone - N202 - 0
NISHA . NA
JAI CHANDEL NA
EKLAVYA CHANDEL NA

HealthReturnsTM (Applicable for Renewal Policy)

Name of the Insured Person HealthReturnsTM carried forward from Previous Year -Total HealthReturnsTM available for utilization

Devender kumar NA 0
NISHA . NA 0
JAI CHANDEL NA 0
EKLAVYA CHANDEL NA 0

Trademarks - HealthReturnsTM, Healthy Heart Score and Active Dayz are owned by MMI Group Limited and used under license by
Aditya Birla Health Insurance Co. Limited.

Nominee Name Nominee Relationship with Policyholder Nominee Contact Number

NISHA . Spouse NA
Appointee Details: (Required only if Nominee is a Minor)
Appointee Name Relationship with Nominee
NA NA
Note - A Minor should not be declared as Appointee.

Yes

Product Name: Activ One, Product UIN: ADIHLIP24097V012324

 Total Ported Sum
Insured (Sum
Date of first Previous Policy Type of Waiting period
Name of Insured Person Previous Insurer Insured +
enrollment Number Cover waived off
Cumulative
Bonus)
No waiting
period for SI
Aditya Birla Health Insurance Co. 31-25-0408045- 470000;24
Devender kumar 28-01-2026 Floater 1000000
Ltd. 00 Months waived
off on SI
530000;
Devender kumar 28-01-2024 Care Health Insurance Ltd 77070594 Floater NA NA
HDFC ERGO General Insurance 28062035754104
Devender kumar 28-01-2013 Floater NA NA
Co. Ltd. 03001
No waiting
period for SI
Aditya Birla Health Insurance Co. 31-25-0408045- 470000;24
EKLAVYA CHANDEL 28-01-2026 Floater 1000000
Ltd. 00 Months waived
off on SI
530000;
EKLAVYA CHANDEL 28-01-2024 Care Health Insurance Ltd 77070594 Floater NA NA
HDFC ERGO General Insurance 28062035754104
EKLAVYA CHANDEL 28-01-2022 Floater NA NA
Co. Ltd. 03001
JAI CHANDEL 28-01-2024 Care Health Insurance Ltd 77070594 Floater NA NA
HDFC ERGO General Insurance 28062035754104
JAI CHANDEL 28-01-2013 Floater NA NA
Co. Ltd. 03001
No waiting
period for SI
Aditya Birla Health Insurance Co. 31-25-0408045- 470000;24
JAI CHANDEL 28-01-2026 Floater 1000000
Ltd. 00 Months waived
off on SI
530000;
NISHA . 28-01-2024 Care Health Insurance Ltd 77070594 Floater NA NA
HDFC ERGO General Insurance 28062035754104
NISHA . 28-01-2013 Floater NA NA
Co. Ltd. 03001
No waiting
period for SI
Aditya Birla Health Insurance Co. 31-25-0408045- 470000;24
NISHA . 28-01-2026 Floater 1000000
Ltd. 00 Months waived
off on SI
530000;

Product Name: Activ One, Product UIN: ADIHLIP24097V012324

 Product Name Activ One
Plan Variant MAX
Refer Base Sum Insured column under Insured Person’s
Base Sum Insured
details above
Basic Covers Hospitalization Room Rent Single Private Room
Treatment ICU Charges Actuals up to Sum Insured
Road Ambulance Cover (per
Actuals up to Sum Insured
hospitalization)
Day Care Treatments Actuals up to Sum Insured
Modern Procedures / Treatments Actuals up to Sum Insured for listed procedures
HIV / AIDS and STD Cover Actuals up to Sum Insured
Mental Illness Hospitalization Actuals up to Sum Insured
Obesity Treatment Actuals up to Sum Insured
Pre-Hospitalization Expenses (up to Sum Insured) 90 Days
Post-Hospitalization Expenses (up to Sum Insured) 180 Days
Claim Protect (Non-Medical Expense Waiver) Waiver of Non-Medical Expense Exclusion of Base Policy
List as per Annexure 1 (all 4 lists)

Domiciliary Hospitalization Actuals up to Sum Insured

Home Health Care Actuals up to Sum Insured
AYUSH Treatment Actuals up to Sum Insured
Organ Donor Expenses Actuals up to Sum Insured
Annual Health Check up (Listed & Cashless) Covered
Super Reload Unlimited Refill [2nd Claim onwards -
Unlimited Covered
Times (upto Base Sum Insured)]
Super Credit (increases irrespective of claim) 100% of SI per year, up to 500% of Base Sum Insured
(up to Max of 3 Cr under this benefit)
Health Management Program Health AssessmentTM Available once in a policy year undertaken at our
Network Providers / Empaneled Service Providers on a
cashless basis only / on digital basis

HealthReturnsTM Available up to 100% of the Premium

Premium for
Premium for
Other Optional Loading Discounts
Base and CGST SGST/UTGST IGST Other taxes/Cess Total Premium
Covers (if applicable) (if applicable)
Related Covers
(If Opted)

29472.12 400 0 0 0 0 0 0 29872.00

GST Registration No: 27AANCA4062G1ZN PAN Number :AANCA4062G Category: General Insurance SAC Code: 997133

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.

Consolidated Stamp Duty paid vide E-challan GRN no. MH001265008202526E & 25/04/2025

For and on behalf of Aditya Birla Health Insurance Co. Ltd

Date : 28/01/2026

Location : Mumbai
Authorized Signatory

Product Name: Activ One, Product UIN: ADIHLIP24097V012324

 Premium Certificate
We confirm the receipt of premium amount of INR 29872.00 as per below details paid by Mr. Devender kumar for Self and/or Family and/or
Parents:

Policy Number: 31-25-0408045-00 Plan Name: MAX

Type of Plan: Family Floater Proposer Name: Devender kumar

Policy Start Date: 00:00 hrs on 28/01/2026 Policy End Date: 23:59 hrs on 27/01/2027

Premium Details:

Premium Date Net Premium Amount CGST SGST IGST Total Premium Total Premium Paid

12-12-2025 29872.12 0 0 0 29872.00 29872

Mode of Premium payment Single

Year wise breakup of premium for the purpose of claiming Income Tax deduction u/s 80D (subject provisions of Income Tax Act) is
provided as under:
Financial Year Year wise proportionate Premium amount*
2025-26 29,872.00

0 • Premium paid in cash(Rs. 0), premium paid using HealthReturnsTM, and premium paid towards Personal Accident, Wellness Coach do not
qualify for deduction u/s 80D. Further premium paid for person other than family member & parents (as defined under Income Tax Act)
also don’t qualify for deduction under section 80D.

Amount is rounded off to nearest rupee and is inclusive of all taxes and cesses as applicable. For exact premium, please refer to Section
VII of Policy schedule
Note:
1. The year wise deductions as mentioned above are as per provision of Section 80D and this would be subjected to the specified annual
limits and other provisions as applicable for respective years as per applicable provisions of Income Tax Act.
2. Deduction under section 80D of the Act is allowed to the person who pays premium out of his/her income chargeable to tax.
3. Deduction under section 80D of the Act is available on realization of premium paid by Policyholder.
4. Tax laws are subject to change and any such change could have a retrospective effect. This letter should not be construed as tax,
legal or investment opinion from us. For specific suitability, you are requested to consult your tax advisor.
5. This receipt must be surrendered to the company, in case of cancellation of this policy. In event of incorrect representation of this
declaration the liability shall be upon the policy holder.

For and on behalf of Aditya Birla Health Insurance Co.

Limited

Date : 28/01/2026

Place : Mumbai
Authorized Signatory

Product Name: Activ One, Product UIN: ADIHLIP24097V012324

POLICY NO. 31-25-0408045-00
Name Membership No. DOB
Devender kumar PT43356024 15/Jul/1979
NISHA . PT43356028 01/Feb/1985
JAI CHANDEL PT43356029 08/Apr/2010
EKLAVYA CHANDEL PT43356030 16/Dec/2022
 Activ One MAX
CUSTOMER INFORMATION SHEET /
KNOW YOUR POLICY
This document provides key information about your policy. You are also advised to go through your policy document.

POLICY CLAUSE
SR. No. TITLE DESCRIPTION
NUMBER
01. Product Name Activ One MAX
02. Policy Number 31-25-0408045-00

Type of Insurance Both Indemnity and Benefit

03.
Product/Policy
04. Sum Insured (Basis) Individual Sum insured – Each member has separate sum
(Along with amount) Insured under the policy
Floater Sum Insured-where all member under the policy have a
single sum insured limit which may be utilized by any or all
members

Insured Person Family Floater Sum Insured

Devender kumar
EKLAVYA CHANDEL
1000000
JAI CHANDEL
NISHA .

Family Floater
05. Policy Coverage I. Basic covers
(What the policy
1. Hospitalization Treatment C.1
covers?)
2. Pre-Hospitalization Expenses C.2
3. Post-Hospitalization Expenses C.3
4. Claim Protect (Non-Medical Expense Waiver) C.4
5. Domiciliary Hospitalization C.5
6. Home Health Care C.6
7. AYUSH Treatment C.7
8. Organ Donor Expenses C.8
9. Annual Health Check-up C.9
10. Super Reload C.10
11. Super Credit C.11
12. Health Management Program C. 12
II. Optional Covers: (Available if opted by paying C.13
additional premium)
13. Reduction in Specific Disease waiting period C.13.1
14. Reduction in Pre-Existing Disease waiting period C.13.2
15. Room Rent Type Options C.13.3
16. Per Claim Deductible C.13.4
17. Preferred Provider Network (PPN) Discount C.13.5
18. Critical Illness cover C.13.6

Product Name: Activ One, Product UIN: ADIHLIP24097V012324

 19. Personal Accident Cover (AD+PTD+PPD) C.13.7
20. Chronic Care (Day 1 In-patient Hospitalization) C.13.8
21. Chronic Management Program (OPD) C.13.9
22. Cancer Booster C.13.10
23. Durable Medical Equipment Cover C.13.11
24. Compassionate Visit C.13.12
25. Second Medical Opinion for listed Major Illness C.13.13
26. Annual Screening Package for Cancer Diagnosed Patients C.13.14
III. Optional Add-ons: (Available if opted by paying
additional premium) – Please refer to Policy Schedule

06. Exclusions Standard Exclusion: D.1.4 to D.1.18

(What the policy 1. Investigation & Evaluation (Code- Excl04)
does not cover) 2. Rest Cure, rehabilitation and respite care (Code- Excl05)
3. Obesity/ Weight Control (Code- Excl06)
4. Change-of-Gender treatments: (Code- Excl07)
5. Cosmetic or plastic Surgery: (Code- Excl08)
6. Hazardous or Adventure sports: (Code- Excl09) -.
7. Breach of law: (Code- Excl10)
8. Excluded Providers: (Code- Excl11)
9. Treatment for, Alcoholism, drug or substance abuse
or any addictive condition and consequences thereof.
(Code- Excl12).
10. Treatments received in heath hydros, nature cure clinics,
spas or similar establishments or private beds registered
as a nursing home attached to such establishments or
where admission is arranged wholly or partly for
domestic reasons. (Code- Excl13)
11. Dietary supplements and substances that can be
purchased without prescription, including but not l
imited to Vitamins, minerals and organic substances
unless prescribed by a medical practitioner as part of
hospitalization claim or day care procedure (Code- Excl14)
12. Refractive Error:(Code- Excl15)
13. Unproven Treatments:(Code- Excl16)
14. Sterility and Infertility: (Code- Excl17)
15. Maternity Expenses (Code - Excl18)

Specific Exclusions: D.2.1 to D.2.8

1. Circumstantial Exclusion
2. Behavioural Exclusions
3. Medical Exclusions
4. Prosthesis and Devices
5. Non-Medical expenses
6. Specific treatment Exclusion
7. Activities and Profession Exclusions
8. Geographical Exclusion

Product Name: Activ One, Product UIN: ADIHLIP24097V012324

07. Waiting • Initial waiting Period: 30 days for all illnesses (except D.1.3
period accident) in the first year and is not applicable in
subsequent renewals and policies accepted under
• Time period Portability
during which • For Personal Accident Cover (AD,PTD), no initial waiting
specified disease / period applicable.
treatment is not • For Critical Illness Cover, We shall not be liable to make C.13.6
covered any payment in respect of any Critical Illness whose signs
or symptoms first occur within 60 days from the Inception
• It is counted Date of cover.
from the beginning • Specific Waiting periods (Not applicable for claims arising D.1.2
of the policy due to an accident): 24 months for listed diseases/
coverage procedures
• Pre-Existing Diseases: Covered after 36 months D.1.1
Note: Waiting Periods in force for Insured Persons shall
be as per the plan opted or option selected

08. Financial limits of

coverage

i) Sub-limit (It is a Nil

pre-defined limit
and We will not pay
any amount in
excess of this limit)
ii) Co-payment (It Nil
is a specified
amount /
percentage of the
admissible claim
amount to be
paid by Insured)
iii) Deductible Nil
(It is a specified
amount: - up to
which an insurance
company will not
pay any claim, and -
which will be
deducted from
total claim amount
(if claim amount is
more than the
specified amount)
iv) Any other limit Nil

Product Name: Activ One, Product UIN: ADIHLIP24097V012324

09. Claims / Claims a. For Cashless Service: E.2.7
Procedure Kindly contact us 48 hrs prior for planned
hospitalisation or within 24 hours of
hospitalisation in case of emergency
hospitalisation.

Link for Hospital Network details:

[Link]
healthinsurance/locate-care/hospital-listing

b. For Reimbursement of Claim: E.2.7

Type of claim Prescribed Time Limit
Reimbursement of Within 30 days of
Hospitalization, Day Care date of discharge
Treatment or Pre from Hospital.
Hospitalization Expenses

Reimbursement of Post Within 15 days from

Hospitalization Expenses completion of post
Hospitalization
treatment.

c. For Personal Accident and Critical Illnessbenefits E.2.7.2

• We shall be given an intimation of the claim within 7
days from the date of Accident or diagnosis of the
critical illness or admission in the Hospital.
• The claims documents must be provided to Us within
30 days of occurrence of the event.

10. Policy Servicing ln case of any Policy Services the insured person may contact
the
• Website:
[Link]
• Toll- Free: 1800 270 7000
• E-mail: [Link]@[Link]
(Senior citizens may write to us at:
[Link]@[Link])
• In case you are not satisfied with the resolution you may
write to Head – Customer Care :
[Link]@[Link]
• Courier: Write to Us at below address
Unit no 1101 & 1104 11th floor, Unit no 1501 & 1502 15th
floor, G Corp Tech Park, Kasarwadavali, Ghodbunder
Road, Thane West - 400601

11. Grievances / ln case of any grievance the insured person may contact the E.1.8
Complaints • Website:
[Link]
• Toll- Free: 1800 270 7000
• E-mail: [Link]@[Link]
(Senior citizens may write to us at:
[Link]@[Link])
• In case you are not satisfied with the resolution you may
write to Head – Customer Care :
[Link]@[Link]

Product Name: Activ One, Product UIN: ADIHLIP24097V012324

 • Courier: Write to Us at below address
• Unit no 1101 & 1104 11th floor, Unit no 1501 & 1502 15th
floor, G Corp Tech Park, Kasarwadavali, Ghodbunder
Road,Thane West – 400601
lnsured person may also approach the grievance cell at
any of the company's branches with the details of
grievance.

If lnsured person is not satisfied with the Redressal of

grievance through one of the above methods, insured
person may contact the grievance officer at:
[Link]@[Link]

If Insured Person is not satisfied with the Redressal of

grievance through above methods, the Insured Person
may also approach the office of Insurance Ombudsman of
the respective area/region for Redressal of grievance as
per Insurance Ombudsman Rules 2017 (at the addresses
given in Annexure II of Policy terms and conditions).
Grievance may also be lodged at IRDAI Integrated
Grievance Management System-
[Link]

12. Things to a. Free Look period: The Free Look Period shall be applicable E.1.1
remember on new individual health insurance policies, except for
those policies with tenure of less than a year. Free-look
shall not be applicable on renewals or at the time of
porting / migrating the policy. The Insured Person shall be
allowed Free Look Period of thirty days from date of
receipt of the policy document, whether received
electronically or otherwise, to review the terms and
conditions of the policy, and to return the same if not
acceptable. A request received by insurer for cancellation
of the policy during free look period shall be processed
and premium shall be refunded within 7 days of receipt of
such request.

b. Policy Renewal: The policy shall ordinarily be renewable E.1.3

except on grounds of fraud, moral hazard,
misrepresentation by the insured person. Renewal shall
not be denied on the ground that the insured had made a
claim or claims in the preceding policy years.

c. Migration and Portability: The Insured Person will have E.1.12 & 13
the option to migrate the Policy to other health insurance
products / plans, offered by the Company or to port the
Policy to other insurers

Process for migration:

The Insured Person will have the option to migrate the
Policy to other health insurance products/plans offered
by the Company by applying for Migration of the policy
atleast 30 days before the policy renewal date as per
IRDAI guidelines on Migration.

Process for portability:

The Insured Person will have the option to port the Policy
to other insurers by applying to such Insurer to port the

Product Name: Activ One, Product UIN: ADIHLIP24097V012324

 entire policy along with all the members of the family, if
any, at least 30 days before, but not earlier than 60 days
from the policy renewal date as per IRDAI guidelines
related to Portability

In case the Insured Person wants to migrate or Port their

Health Insurance Policy, then contact Us with the details
through: E-mail ID:
[Link]@[Link]
Toll Free: 1800 270 7000
Address: Any of Our Branch office or Corporate office

d. Changes to Sum Insured on Renewal: You may opt for E.2.5.C

enhancement of Sum Insured at the time of Renewal,
subject to underwriting. All Waiting Periods as defined
in the Policy shall apply afresh for this enhanced limit
from the effective date of such enhancement.

e. Moratorium Period: After completion of sixty continuous E.1.10

months of coverage (including portability and migration)
in health insurance policy, no policy and claim shall be
contestable by the insurer on grounds of non-disclosure,
misrepresentation, except on grounds of established
fraud This period of sixty continuous months is called as
moratorium period. The moratorium would be applicable
for the sums insured of the first Policy. Wherever, the
sum insured is enhanced, completion of sixty continuous
months would be applicable from the date of
enhancement of sums insured only on the enhanced
limits. The accrued credits gained under the ported and
migrated policies shall be counted for the purpose of
calculating the Moratorium period.

13. Insured’s a. The Policy shall be void and all premium paid thereon E.1.14
Obligations shall be forfeited to the Company in the event of
misrepresentation, mis-description or non-disclosure
of any material fact by the policyholder.
b. During the Policy Term any material information
changes on Occupation and/ or Medical Conditions
shall be communicated to Us in a Change Request Form.
This form can be downloaded from Our website or
collected from Our branch office or can also be
obtained by contacting Us over the telephone.

Please refer Policy Schedule for the applicable benefits

Product Name: Activ One, Product UIN: ADIHLIP24097V012324

72

Declaration by the Policy Holder:

I have read the above and confirm having noted the details.

Devender kumar authenticated via OTP for

Place : Faridabad QE1044985382512
On null at 00:00:01
Date :28-JAN-26

(Signature of the Policy Holder)

LEGAL DISCLAIMER NOTE:

The information must be read in conjunction with the product brochure and policy document. In case of any conflict between the
CIS and the policy document, the terms and conditions mentioned in the policy document shall prevail.

Please refer below link for Product related documents

Aditya Birla Health Insurance Download ([Link])