HDFC ERGO General Insurance Company Limited

2805203811531802000

Mr Satish Sudhakar Mandaokar A5 DEVDAR BUILDING,FLAT 603 AND 604,LOK UDHYAN SOCIETY NEAR SANGLEWADI,KALYAN WEST THANE MAHARASHTRA-421301 Contact No.: 9594671111 Policy No : 2805203811531802000 Intermediary Code

Intermediary Name

Intermediary Contact Number

Renewal of Your Optima Restore Floater Insurance Policy Dear Mr Satish Sudhakar Mandaokar , Welcome to HDFC ERGO General Insurance Company Limited. We are pleased to issue you Renewal of Your Optima Restore Floater Insurance Policy. We advise you to retain your Policy Kit during the entire term of the Policy (including renewals). Please note that the Policy has been issued to you based on the declarations, details and documents received from/on behalf of you in/along with the Proposal Form submitted to us. Please visit our website www.hdfcergo.com for more information about our Company, Grievance handling and any other support. To know the updated list of our network hospitals please visit http://www.hdfcergo.com/our-hospitals-network.aspx We value your relationship with us and assure you our best services at all times and we look forward to serve you. Warm Regards,

Location: Mumbai Date: 02/10/2022

Authorized Signatory Note: 1. Please update us with your latest contact details (in case of any change) so that same can be updated in our records. 2. You can either email us on [email protected] or call on our Customer care no. 022 6234 6234 / 0120 6234 6234. 3. *The Copy of the proposal form has been sent on your registered email id if policy is purchased through website.

Certificate for the purpose of deduction under Section 80 D of Income Tax Act, 1961* This is to certify that the Proposer SATISH SUDHAKAR MANDAOKAR has paid Rs.33177 (Rupees THIRTY-THREE THOUSAND ONE HUNDRED SEVENTY-SEVEN) towards premium for Policy No. 2805203811531802000 issued to MR SATISH SUDHAKAR MANDAOKAR for period 04-Nov-2022 to 03-Nov-2023. For and on behalf of HDFC ERGO General Insurance Company Limited Location: Mumbai Date: 02/10/2022 Authorized Signatory *Note 1.

This is subject to the provisions of Section 80D of Income Tax Act, 1961 as amended from time to time.

2.

This certificate 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 Policyholder. Please note that this certificate will not be issued if the premium payment has been made in cash. In case of dishonor of the premium instrument, the policy will be deemed cancelled ab initio. 80D benefit is applicable for only Self, Spouse, Dependent Children and Dependent parents.

3. 4. 5.

HDFC ERGO General Insurance Company Limited Policy Schedule - Optima Restore Floater

Policy Number Policy Holder’s Name

2805 2038 1153 1802 000 Mr Satish Sudhakar Mandaokar A5 DEVDAR BUILDING,FLAT 603 AND 604,LOK UDHYAN SOCIETY NEAR SANGLEWADI,KALYAN WEST THANE MAHARASHTRA-421301 Maharashtra & 27 Place of Supply MAHARASHTRA

Policy Holder’s Address Policy Holder State Name & Code GSTIN/ UIN (if any) of Policy Holder First policy inception date

04/11/2020

Policy Issuance Date

Policy Period

From 00:01 hrs on 04/11/2022 To 24:00 hrs on 03/11/2023

Issuing/Servicing Office GSTIN EIA Number Intermediary Name Intermediary Code

GURGAON 27AABCL5045N1Z8

02/10/2022

Intermediary Contact No Description/ Harmonized System Of Accident and Health insurance Services/9971 Nomenclature Code

Insured Person Details Member 1 Member 2 SATISH Mrs Shubhangi SUDHAKAR Satish Mandaokar / Particulars / Member ID MANDAOKAR / 2020010003531535 2020010003531534 Date of Birth (Age) 06/06/1967 (55) 18/06/1968 (54) Relationship to Policy Holder Self Wife Base Sum Insured (`) Multiplier Benefit SI (`) Protector Rider Sum Insured (`) Total Sum Insured (`) Other Riders and Benefits ( `) Protector Rider Hospital Daily Cash Rider SI (Max. 30 days) Critical Advantage Rider SI ($) IPA Rider SI

Member 3

Member 4

Member 5

Member 6

-

-

-

-

500000 500000 1000000 -

-

-

-

-

-

-

-

-

-

-

-

-

my: health Critical Illness Sum Insured (Rs.) my: health Critical Illness Plan Unlimited Restore Benefit

No

Nominee Details Nominee Name : Shubhangi Satish Mandaokar Relationship to Policyholder: Wife The nominee must be an immediate relative of the policyholder. For all other Insured Persons the policy holder shall be the nominee. Premium Calculation (`) Net Premium 29595.8 CGST@0% Discounts 1479.8 SGST/UTGST@0% Loadings 0 IGST@18% Taxable Premium 28116 Any other Cess or Taxes Gross Premium 33177 Gross Premium (in words) Rupees Thirty-Three Thousand One Hundred Seventy-Seven The stamp duty of Rs. 1/- ( Rupees One Only ) paid vide e-stamp Certificate No. LOA/CSD/303/2022/1381 dated 29/03/2022. Original for Recipient/ Duplicate for Supplier Whether tax is payable on reverse charge basis: No

0 0 5061 0

Exclusion(s) / Special Condition(s) (Refer the leaflet attached in the policy document w.r.t. exclusions) : Member ID No. Name Exclusion Type Applicable Health Condition Exclusion Portability/ Renewal Benefit on SI Duration (Years) 2020010003531535 Mrs Shubhangi Satish Pre Existing Disease 500000 HYPOTHYROIDI 1 For Rs 500000(Rupees Five Lakhs) Mandaokar SM_1 Sec 5 A (i) and Sec 5 A (ii) of the policy wording is waived and Sec 5 A (iii) is reduced to 1 year. 2020010003531534 SATISH SUDHAKAR Pre Existing Disease 500000 HYPOTHYROIDI 1 For Rs 500000(Rupees Five Lakhs) MANDAOKAR SM_1 Sec 5 A (i) and Sec 5 A (ii) of the policy wording is waived and Sec 5 A (iii) is reduced to 1 year.

HDFC ERGO General Insurance Company Limited Policy Schedule - Optima Restore Floater

Claim Administrator : HDFC ERGO GENERAL INSURANCE COMPANY LTD

For and on behalf of HDFC ERGO General Insurance Company Limited

Location: Mumbai

Authorized Signatory

Date: 02/10/2022 "For detailed policy terms and conditions please visit our website https://www.hdfcergo.com/download/policy-wordings " SCHEDULE OF BENEFITS In-patient Treatment Pre-Hospitalization Post-Hospitalization Day Care Procedures Domiciliary Treatment Organ Donor Daily Cash for choosing Shared Accommodation

Upto 500000 Upto 500000 for 60 days Upto 500000 for 180 days Upto 500000 Upto 500000 Upto 500000 Rs.800 per day, Maximum Rs.4,800

Ambulance (per hospitalization limit) E-Opinion in respect of a Critical Illness Restore Benefit

Upto Rs.2,000 per Hospitalization One per policy year 100% of Basic SI (for any illness or any insured person) Bonus of 50% of the Basic SI for every claim free policy year, maximum upto 100%. In case of claim, accumulated bonus will be reduced by 50% Upto a maximum of Rs.2,500 per policy, only once at the end of a block of every continous two policy years.

Multiplier Benefit Preventive Health Check-up (Floater)

HDFC ERGO General Insurance Company Limited

Policy No.: 2805203811531802000

Insured Name

Gender

Mrs Shubhangi Satish Mandaokar

Female

Satish Sudhakar Mandaokar

Male

Terms and Conditions (1) This card would be valid till your relationship with HDFC ERGO General Insurance Company Limited / This card is invalid if the policy is cancelled (2) In case of renewal please refer original policy number (3) This card is issued for the purpose of identification only and does not entail automatic cashless facility at the network hospital. (4) A photo ID issued b y any government authority i s to be produced to avail cashless facility. (5) Please apply for cashless facility 48 hours prior to admission in case of planned admissions and within 24 hours of admission in case of emergency.(6) All terms and conditions of the policy would be applicable while processing your cashless request. (7) In case your cashless facility i s denied due to any reason, please submit the claim for reimbursement. Denial of cashless facility does not indicate rejection of the claim. (8) Please read policy documents carefully for detailed terms and conditions. For claim status visit help section on our web site www.hdfcergo.com. Alternatively you may write to us at [email protected]. HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146 CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. Health Claim Services Address : HDFC ERGO General Insurance Company Limited Stellar IT Park, Tower-1 , 5th Floor, C - 25, Noida, Sector 62, 201301, Uttar Pradesh. Service No. 022-62346234/ 0120-62346234Email: [email protected] Logo displayed above belongs to HDFC Ltd and ERGO International AG and used by the Company under license.

HDFC ERGO General Insurance Company Limited

Member Name

SATISH SUDHAKAR MANDAOKAR

Health Condition

HYPOTHYROIDISM_1

Health Conditions Elaboration ICD CODE Description E03.0 Congenital hypothyroidism with diffuse goitre E03.1 Congenital hypothyroidism without goitre E03.2 Hypothyroidism due to medicaments and other exogenous substances E03.3 Postinfectious hypothyroidism E03.4 Atrophy of thyroid (acquired) E03.5 Myxoedema coma E03.8 Other specified hypothyroidism E03.9 Hypothyroidism, unspecified Member Name

Mrs Shubhangi Satish Mandaokar

Health Condition

HYPOTHYROIDISM_1

Health Conditions Elaboration ICD CODE Description E03.0 Congenital hypothyroidism with diffuse goitre E03.1 Congenital hypothyroidism without goitre E03.2 Hypothyroidism due to medicaments and other exogenous substances E03.3 Postinfectious hypothyroidism E03.4 Atrophy of thyroid (acquired) E03.5 Myxoedema coma E03.8 Other specified hypothyroidism E03.9 Hypothyroidism, unspecified

*For services like second opinion, doctor appointment facilitating hospitalisation, post hospitalisation care, call our Health Assistant Helpline at 040-66274205 ( 8AM to 8PM Monday to Saturday except public holidays) This card is not transferable and is valid at network hospitals only.

Company Name

: Everestek Technosoft Solutions Private Limited

Name

: Sachin Gangaram Teli

Age

: 37

Card No

: IL21469832302

Policy No

: 4016 X 259741092 00 000

ICICI Lombard health care pays: hospitalisation bills for admissible claim, subject to prior approval. In case of emergency, approval can be taken within 24 hours of hospitalization.

Employee ID

: 154

Insured Pays : All non-medical hospitalisation bills and expenses not covered under the policy.

Gender

Valid From : 14 September, 2022 September, 2023

: MALE

Use of this card is governed by the policy terms and conditions Cashless access to the network provider can be only obtained when accompanied with an authorisation letter issued by ICICI Lombard GIC Ltd. In case of non photo cards, to prove your identity, please produce this card along with any photo ID card issued by Government Valid up to policy expiry date or cancellation date which river is earlier.

Valid To : 13

Mailing Address: ICICI Lombard Healthcare, ICICI Bank Tower, Plot No. 12, Financial District, Nanakram Guda, Gachibowli, Hyderabad-500032 Registered Address: ICICI Lombard General Insurance Company Limited, ICICI Lombard house, 414, Veer Savarkar Marg, Near Siddhivinayak Temple, Prabhadevi, Mumbai - 400 025 Fax number: (040) 66989160/61 Email: [email protected]

Toll Free Number: 1800 2666 Visit us at : www.icicilombard.com

Insurance is the subject of matter of the solicitation. IRDA Reg: 115, CIN: L67200MH2000PLC129408 *The mentioned covers are the add-ons b y paying additional premium and availab le only if opted b y the policyholders.

LEAVE AND LICENSE AGREEMENT

Particulars

Amount Paid

GRN/Transaction Id

Date

Stamp Duty

Rs. 517.90/-

MH009381810202223E

17/10/2022

Registration Fee

Rs. 1000/-

MH009381810202223E

17/10/2022

LEAVE AND LICENSE AGREEMENT This agreement is made and executed on 17/10/2022 at Kalyan Between, 1) Name: Mr.Pandey Arvind Nanku, Age : About 46 Years, Occupation : Business, PAN : AKQPP4691N Residing at: Flat No:304, Floor No:3rd Floor, Building Name:Sanskruti CHS, Block Sector:Rambaug Lane No.4, Road:Near Ganesh Temple, Kalyan West, Thane, Maharashtra, 421301 HEREINAFTER called ‘the Licensor (which expression shall mean and include the Licensor above named and also his/her/their respective heirs, successors, assigns, executors and administrators) AND 1) Name: Miss Mandaokar Sayalee Satish, Age : About 30 Years, PAN : CQIPM8541C Residing at: Flat No:A/608, Floor No:6th, Building Name:Anant Regency, Block Sector:Near Suresh Cable, Road:Rambag Lane 4, Kalyan West, Thane, Maharashtra, 421301 HEREINAFTER called ‘the Licensee’ (which expression shall mean and include only Licensee above named). WHEREAS the Licensor is absolutely seized and possessed of and or otherwise well and sufficiently entitled to all that constructed portion being unit described in Schedule I hereunder written and are hereafter for the sake of brevity called or referred to as Licensed Premises and is/are desirous of giving the said premises on Leave and License basis under Section 24 of the Maharashtra Rent Control Act, 1999. AND WHEREAS the Licensee herein is in need of temporary premises for Residential use has/have approached the Licensor with a request to allow the Licensee herein to use and occupy the said premises on Leave and License basis for a period of 11 Months commencing from 14/10/2022 and ending on 13/09/2023, on terms and subject to conditions hereafter appearing. AND WHEREAS the Licensor have agreed to allow the Licensee herein to use and occupy the said Licensed premises for her aforesaid Residential purposes only, on Leave and License basis for above mentioned period, on terms and subject to conditions hereafter appearing; NOW THEREFORE IT IS HEREBY AGREED TO, DECLARED AND RECORDED BY AND BETWEEN THE PARTIES HERETO AS FOLLOWS:1) Period: That the Licensor hereby grants to the Licensee herein a revocable leave and license, to occupy the Licensed Premises, described in Schedule I hereunder written without creating any tenancy rights or any other rights, title and interest in favour of the Licensee for a period of 11 Months commencing from 14/10/2022 and ending on 13/09/2023 Registered as Document No.11272/2022 at the S.R. Kalyan 1 on 19/10/2022

Page 1 of 5

LEAVE AND LICENSE AGREEMENT

2) License Fee & Deposit:That the Licensee shall pay to the Licensor License fee at the rate of Rs. 18000(Eighteen Thousand Only) per month towards the compensation and Rs. 100000(One Lakh Only) interest free refundable deposit, for the use of the said Licensed premises. The amount of monthly compensation License fee shall be payable within first five days of the concerned month of Leave and License. 3) Payment of Deposit:1] That the Licensee have paid / shall pay the above mentioned deposit/premium as mentioned above by Transaction Reference No. MAHBH20213645893, dated – 31/07/2020, drawn on the Licensee’s Banking Account with Bank of maharashtra Bank, Kalyan Branch. Amount Rs.70000/-(Seventy Thousand Only) 2] That the Licensee have paid / shall pay the above mentioned deposit/premium as mentioned above by Transaction Reference No. MAHBH21314502662, dated – 10/11/2021, drawn on the Licensee’s Banking Account with Bank of maharashtra Bank, Kalyan Branch. Amount Rs.30000/-(Thirty Thousand Only) 4) Maintenance Charges: That the all outgoings including all rates, taxes, levies, assessment, maintenance charges, non occupancy charges, etc. in respect of the said premises shall be paid by the Licensor. 5) Electricity Charges: The licensee herein shall pay the electricity bills directly for energy consumed on the licensed premises and should submit original receipts to Licensor indicating that the electricity bills are paid. 6) Use: That the Licensed premises shall only be used by the Licensee for Residential purpose.The Licensee shall maintain the said premises in its existing condition and damage, if any, caused to the said premises, the same shall be repaired by the Licensee at its own cost subject to normal wear and tear. The Licensee shall not do anything in the said premises which is or is likely to cause a nuisance to the other occupants of the said building or to the prejudice in any manner to the rights of Licensor in respect of said premises or shall not do any unlawful activities prohibited by State or Central Government . 7) Alteration: That the Licensee shall not make or permit to do any alteration or addition to the construction or arrangements (internal or external) to the Licensed premises without previous consent in writing from the Licensor. 8) No Tenancy: That the Licensee shall not claim any tenancy right and shall not have any right to transfer, assign, and sublet or grant any license or sub-license in respect of the Licensed Premises or any part thereof and also shall not mortgage or raise any loan against the said premises. 9) Inspection: That, the Licensor shall on reasonable notice given by the Licensor to the Licensee shall have a right of access either by himself / herself / themselves or through authorized representative to enter, view and inspect the Licensed premises at reasonable intervals.

Registered as Document No.11272/2022 at the S.R. Kalyan 1 on 19/10/2022

Page 2 of 5

LEAVE AND LICENSE AGREEMENT

10) Lock in period: Both the parties have agreed to set a lock-in period of 3 months during which neither the Licensor shall ask the licensee to vacate the premises, nor the licensee shall vacate the premises on his own during the lock-in period.In spite of this mandatory clause, if the licensee leaves the premises for whatsoever reason, he shall pay to the Licensor license fee for the remaining lock-in period at the rate of agreed upon in the agreement. On the other hand, Licensor shall compensate the Licensee for loss and inconvenience caused to the Licensee if he has been asked to vacate the premises. 11) Cancellation: That, Subject to the condition of lock in period (if any), if the Licensee commits default in regular and punctual payments of monthly compensation as herein before mentioned or commit/s breach of any of the terms, covenants and conditions of this agreement or if any legislation prohibiting the Leave and License is imposed, the Licensor shall be entitled to revoke and / or cancel the License hereby granted, by giving notice in writing of one month and the Licensee too will have the right to vacate the said premises by giving a notice in writing of one month to the Licensor as mentioned earlier. 12) Possession: That the immediately at on the expiration or termination or cancellation of this agreement the Licensee shall vacate the said premises without delay with all her goods and belongings. In the event of the Licensee failing and / or neglecting to remove herself and / or her articles from the said premises on expiry or sooner determination of this Agreement ,the Licensor shall be entitled to recover damages at the rate of double the daily amount of compensation per day and or alternatively the Licensor shall be entitled to remove the Licensee and her belongings from the Licensed premises, without recourse to the Court of Law. 13) Registration: This Agreement is to be registered and the expenditure of Stamp duty and registration fees and incidental charges, if any, shall be borne by the Licensee and Licensor equally . SCHEDULE I (Being the correct description of premise Apartment/Flat which is the subject matter of these presents) All that constructed portion being Residential unit bearing Apartment/Flat No. 304, Built-up :980 Square Feet, situated on the 3rd Floor Floor of a Building known as 'Sanskruti CHS' standing on the plot of land bearing Survey Number :-,Road: Near Ganesh Temple, Rambaug Lane No.4, Location: Kalyan West 421301, of Village:Chikanghar,situated within the revenue limits of Tehsil Kalyan and Dist Thane and situated within the limits of Kalyan-Dombivli Municipal Corporation. IN WITNESS WHEREOF the parties hereto have set and subscribed their respective signatures by way of putting thumb impression electronic signature hereto in the presence of witness, who are identifying the executants, on the day, month and year first above written.

Registered as Document No.11272/2022 at the S.R. Kalyan 1 on 19/10/2022

Page 3 of 5

LEAVE AND LICENSE AGREEMENT

Name & Address

Photo

Thumb Image

Digitally signed

Licensor Mr.Pandey Arvind Nanku Address:Flat No:304, Floor No:3rd Floor, Building Name:Sanskruti CHS, Block Sector:Rambaug Lane No.4, Road:Near Ganesh Temple, Kalyan West, Thane, Maharashtra, 421301

Not Available

Licensee Miss Mandaokar Sayalee Satish Address:Flat No:A/608, Floor No:6th, Building Name:Anant Regency, Block Sector:Near Suresh Cable, Road:Rambag Lane 4, Kalyan West, Thane, Maharashtra, 421301

Not Available

Witness of execution of all executants Kedari Vijay Address: Block Sector:Kalyan, Road:Murbad Road, Kalyan West, Thane, Maharashtra, 421301

Not Required

Witness of execution of all executants Bhalekar Vilas Address: Block Sector:Kalyan, Road:Murbad Road, Kalyan West, Thane, Maharashtra, 421301

Not Required

_______________________________________________________________________ Admission Of Execution / Identification The following parties have admitted that they have executed the Agreement of Leave and Licenses & the identifires have stated that they are well acquainting to the said parties.They have given their consent to, Department of Stamp and Registration,Maharashtra State to obtain their Aadhaar number, Name and fingerprint for authentication with UIDAI and their identity has been verified with the UIDAI.

Registered as Document No.11272/2022 at the S.R. Kalyan 1 on 19/10/2022

Page 4 of 5

LEAVE AND LICENSE AGREEMENT

Type of Party, Date & Time of Date ,Time of Name & UID Admission Verification with UIDAI

Information received from UIDAI(Name,Gender,Aadhaar No,Photo)

Licensor Pandey Arvind 16/10/2022 12:51:17 PM Nanku

16/10/2022 12:53:01 PM

Arvind Nanku Pandey, Male, XXXX XXXX 4255

Licensee Miss Mandaokar15/10/2022 Sayalee Satish 07:57:11 PM

15/10/2022 07:57:27 PM

Sayalee Satish Mandaokar, Female, XXXX XXXX 6691

identifier for all 17/10/2022 executants 10:59:41 AM Kedari Vijay

17/10/2022 11:01:32 AM

Vijay Rajendra Kedari, Male, XXXX XXXX 2506

identifier for all 17/10/2022 executants Bhalekar Vilas 11:07:09 AM

17/10/2022 11:07:33 AM

VILAS GANPAT BHALEKAR, Male, XXXX XXXX 9420

Thumb Impression of SRO Registered as Document No.11272/2022 at the S.R. Kalyan 1 on 19/10/2022

Page 5 of 5