Pradhan Mantri Suraksha Bima Yojana (PMSBY)
Group Personal Accident Insurance Scheme
Customer ID
:
SB01000031
Bank Name
:
Master Policy Holder
:
Union Bank of India
Branch Name
:
Insured's Details
Insured Name
:
Insured Address
:
Issuing Office Details
JOHN KLOK
Office Code
#203 A ,Prestige Silverwoods Bangalore Karnataka
Address
:
DO_111900
:
Asian Building, Ground Floor 17,R. Kamani
IN 560096
:
02/04/1982
Account No.
:
77700031
Aadhar No.
:
PAN No.
:
Date of Birth (DD/MM/YYYY)
Union Bank of India
Marg,Ballard Estate Mumbai-400038
Phone No.
:
22679075 (D),22613674/75, 24620360/61/62/63
E-mail/Fax
:
[email protected]
:
AAACN4165CST178
S.Tax Regn. No.
AQXPM1923C
Policy Details
Certificate Number
:
42150103023110
Reference Number
:
NIA-UBIN-77700031
Master Policy Number
:
1119004215010000113
Policy start Date
:
01/06/2015 00:00:01
Previous Policy No.
:
NA
Policy end Date
:
31/05/2016 23:59:59
Name of assignee
:
Date of Proposal
:
11/05/2015
Assignee Relationship
:
Premium
12.00
Service Tax
0.00
Frequency of Premium
ANNUAL
Total (Rs.)
12.00
Rupees (in words)
Credit Advice No. & Date
RUPEES TWELVE ONLY
000000000000031 & 25/05/2015
Details of the coverages under the Policy: INDIVIDUAL
Coverages
Sum Assured
Death
Rs 2 Lakhs
Total and irrecoverable loss of both eyes or loss of use of both hands or feet or loss of sight of one eye and loss of
use of hand or foot
Total and irrecoverable loss of sight of one eyes or loss of use of one hand or foot
Rs 2 Lakhs
Rs 1 Lakhs
This is to certify that the above member is covered under the scheme of insurance effected under the above master policy. Insurence benefits are
available to the member subject to the conditions specified in the policy documents.
This is a computer generated document and does not require any signature
Note : 1) This certificate is primarily issued to create awareness about insurance affected in the life of the member. It does not confer any legal
rights on the nominee/or any other person to claim the benefits under the policy. the benefits will be payable only to the authorised person specified
in the policy and subject to the fulfilment of the conditions specified therein. 2) For informing about lodging of claims under the Scheme, please
contact the bank.
Policy No. :42150103023110 Document generated by Portal at 25/05/2015 00:00:00 hours.
Regd. & Head Office: New India Assurance Bldg., 87 M.G.Road,Fort,Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
For Redressal of your grievance, if any, you may approach any one of the following offices- 1. Policy issuing office 2. Regional office 3.Head office. In case, you are not satisfied with our own
grievance redressal mechanism; you may also approach Insurance Ombudsman. For details of our office addresses and addresses of Insurance Ombudsman, please visit our website