Joining Kit (USED)

EMPLOYEE JOINING FORM

EMPLOYEE NAME

Last Name

First Name

Middle Name

Title (Mr/Ms)

Name mentioned in the Graduation Certificate

DATE OF BIRTH

MARITAL STATUS

PASSPPORT DETAILS (if any)

Nationality

Passport Issued CountryPassport NumberPassport Issued DateValid till

DATE OF JOINING AXIS BANK

FATHER’S NAME (Full Name)

SPOUSE NAME (Full name)

GRADE IN AXIS BANK

JOB ROLE IN AXIS BANK

5 DAY WORKING GROUP (Yes/No)

GROUP (MT/NON MT/OTHERS etc)

ORGANIZATION WHERE EMPLOYEE ATTACHED (Department/Branch/Office)ORGANIZATION WHERE EMPLOYEE POSTED (Department/Branch/Office)

SUPERVISOR DETAILS

Appraiser Name

Emp. No.

Job Role

Organization (Dept/Branch/Office

EMPLOYEE SIGNATURE

SUPERVISOR SIGNATURE

NAME OF THE HR RM/Branch Head (In case of Branch Staff)

SIGNATURE OF HR RM/Branch Head

DATE

For MIS CELL Date of Creation

Form 1

NAME:

CONTACT NO.

EMPL. NO:

CHECKLIST A) FORMS TO BE SUBMITTED:

Form No.

Particulars /Remark

1 Joining form-To be Submitted on the Day of Joining

2 Attestation Form And One Photograph3 Declaration of Fidelity And Secrecy4 Declaration to be Bound by Staff Rules5 Declaration of Caste6 Code of Conduct for Prevention of Insider

Trading7 Statement of Assets and Liabilities8 PAN Number/Savings Account Number 9 Declaration for not sharing passwords

B) DOCUMENTS TO BE SUBMITTED:

Sr.No. Particulars /Remark1 All Academic Certificates-(10th ,12th ,

Graduation)2 Professional Degree Certificate (If applicable)3 Proof of Date of Birth- (SSC

Certificate/SLC/PAN Card)4 Relieving Letter/Affidavit (If applicable)

C) UPDATION IN HRMS SITE:

Upon creation of employee number you are requested to update the following forms online in HRMS site and the printout of the same may be taken and submitted along with the other documents:

Sr.No. Particulars /Remark1 Declaration of Dependents2 Provident Form3 Gratuity(Beneficiary) Form4 Group Mediclaim Form5 General Insurance

D) OTHER FORMS TO BE SENT TO RESPECTIVE DEPARTMENTS UPON JOINING:

Form no.

Particulars /Remark

10 Webmail ID request form (To be forwarded to

1

IT department-It should be mailed to [email protected] through Departmental Head /Branch Head ID)

11 ID Card request form(To be forwarded to Administration Department)

Confirmation in the Bank will be subject to completion of all the above-mentioned Joining Formalities.

Annexure 1 to 4 (Page no. 15– 27) are for the reference of the employee and need not be submitted.

Date Place Employee Signature

Useful links:

HRMS site link http://hrms.axisb.com HRMS helpdesk http://hrms.axisb.com Axis Bank HR Help desk Axis Payroll Help

Desk We connect http://we-connect/ HR Circulars http://iim.axisb.com///IIM//inbox.aspx

In case of any query, you may get in touch with HR RM _____________________ at ________.

2

AXIS Bank Ltd. Emp. No. __________

Attestation Form

(To be filled in by the Employee)

1. Name in full Shri/Smt./Kum. __________________________________________________ (IN BLOCK LETTERS)

2. (a) Academic / Educational qualifications

Examination passed Name of Board / University

Principal / Main

Subject(s)

Month & year of Exam.

% of marks obtained in aggregate

Matriculation / SSC ( old pattern ) / SSLC / X std. of 10+2+3 pattern or equivalent

Higher Secondary10+2 of 10+2+3 pattern / 11th std. of 11+3 pattern / Intermediate / Pre-university or equivalent

Bachelor’s Degree. (please tick)

( B. A. / B.Com. / B.Sc. )

Post-Graduation (please tick)

( M. A. / M.Com. / M.Sc. )

__________

2 (b) Professional Degree / Any other (please specify )Examination passed Name of Board /

UniversityPrincipal /

Main Subject(s)

Month & year of Exam.

% of marks obtained in aggregate

_____________________________

_________________

_________________ ______________

__________

___________ ___________

3

Form 2

PHOTO

Emp. No. __________

3. Date of Birth In figures :( In Christian Era ) In words :

4. Present Age : Years Months Days

5. Date of joining :

6. Nature of Appointment :

7. Full postal address with Pin Code :

a) Permanent :_________________________________________________________

__________________________________________________________

__________________________________________________________

b) Local :_________________________________________________________

__________________________________________________________

__________________________________________________________

10. Place of birth :( Give details )

11. Place of domicile :( Give details )

12. (a) Nationality :

(b) Religion :

13. Emergency Contact :a) Name & Address. : ___________________________________________

___________________________________________ ___________________________________________

b) Phone Number. : ___________________________________________

14. Blood Group :

Emp. No. __________

4

15. Previous Experience : Yes / No (if yes, Starting with the present employer)

Sr.No

Name of the Organisation(Starting with the Present Employer)

From Date

To Date Designation

(Please use separate sheet if required)

16. Knowledge ofa) Shorthand and typewriting :

( if any ) with speed

b) Computers :

c) Any other :

17. Father’s/Husband’s name :

18. Father’s/Husband’s occupation :

19. Whether married or single :

20. Whether you were ever arrested for any reason or convicted or committedto prison or subjected to preventivedetention or subjected to any penaltiesor adjudicated insolvent :

I hereby declare that all the information and particulars given by me in this form are true and correct. I also note that that if any of the above statements is incorrect or false or if any material information or particulars have been suppressed or omitted therefrom, my appointment will be liable to be terminated without any notice or any compensation in lieu of notice.

Place : Date :

( Signature )

5

Emp. No. __________

AXIS BANK LTD.

Declaration of Fidelity and Secrecy

Place : ________

Date : _________

I _______________________________________________________ do hereby declare that I will faithfully, truly

and to the best of my skill and ability execute and perform the duties required of me as an

employee of the AXIS Bank Ltd. And which properly relate to the office or position held by me in or

in relation to the said Bank.

I further declare that I will not communicate or allow to be communicated to any person not legally

entitled thereto any information relating to the affairs of the AXIS Bank or relating to the affairs of

any person having any dealing with the AXIS Bank, nor will I allow any such person to inspect or

have access to any books or documents belonging to or in the possession of the AXIS Bank and

relating to the business of the AXIS Bank or the business of any person having any dealing with the

Bank.

( Signature )

Name in full :

Grade :

6

Form 3

Emp. No. __________

AXIS BANK LTD.

Declaration to be bound by the Staff Rules

Place : ________

Date : _________

I hereby declare that I have read and understood the AXIS Bank ( Staff ) Rules, 1994, and I hereby

subscribe to and agree to be bound by the said Rules, as may be in force from time to time.

( Signature )

Name in full :

Grade :

7

Form 4

Emp. No. __________

The Executive Director,AXIS Bank Limited,Central Office,Mumbai.

Dear Sir,

I hereby declare that :

a) I belong to the Scheduled Caste/Scheduled Tribe as per details below,

(i) Name of Caste/Tribe :

(ii) Documentary evidence insupport of my statement :

b) I do not belong to any Scheduled Caste/Tribe

(strike out whichever is not applicable)

Place : _______________ Signature : _____________________

Date : _______________ Name : _____________________

Designation : _____________________

8

Form 5

Emp. No. __________

AXIS BANK LIMITEDACKNOWLEDGMENT

CODE OF CONDUCT FOR PREVENTION OF INSIDER TRADING

I, ________________________________________, an Employee of AXIS Bank Ltd., acknowledge receipt

of letter dated 19th September, 2002 and dos and don’ts regarding the Code of Conduct for

Prevention of Insider Trading.

I agree to comply with the terms and conditions.

Place: Signature

Date: Name of the Employee

Designation/ Employee No.

Form 6

9

Emp. No. __________

STATEMENT OF ASSETS AND LIABILITIES AS ON 31 ST MARCH

(Officers posted in branches and zonal offices should submit the form to their respective Zonal Heads. Zonal Heads and officers in Central Office should submit their forms to the Senior Vice President, HR Department at Central Office).

LIABILITIES

Rs. ____________

1. Borrowings from the Bank -

2. Borrowings from other Institutions -

3. Borrowings from others -

ASSETS

Rs. Balances / Value __________

1. Bank deposits including cash and savings bank balances -

2. Investments and Financial Securities (to include Bonds, Shares, PPF, NSCs, LIC Policies, Holdings in Mutual Funds etc.)

3. Immovable Property -(Please specify whether Land/House/Shop/Building)

Name :

Designation :

Present Posting: ___________________ (Signature)

Form 7

10

Emp. No. __________

AXIS BANK LTD.

PAN NUMBER AND SAVINGS BANK ACCOUNT NUMBER

Employee No. : ______________

Name of Employee : ______________________

Designation : ______________________

Branch / Zone : ______________________

PAN Number : ______________________

Savings Bank A/c : ______________________ (15 digits)

Place : ____________

Date : ____________ Signature : ________________

Form 8

11

Emp. No. __________

DECLARATION TO BE OBTAINED AT THE TIME OF JOINING

I will not share my Finacle password or any other password with anybody under any circumstances at any point of time.

I understand that should it come to the Bank’s notice that I have shared my password with anybody, the Bank is at liberty to take any action against me as deemed fit.

Signature : -

Name : -

Branch/Department : -

Date : -

Form 9

12

WEBMAIL ID REQUEST FORMAXIS BANK Ltd.

Request Form No.: 0001

To,Notes Administrator,AXIS Bank Ltd.,Data Centre, Chembur,Mumbai.

Employee Name: __________________________

Employee No.: __________________________

Designation: __________________________

Date of Joining: __________________________

Place of Posting: __________________________

Transfer (If Applicable ):

1. The above employee stands transferred to ____________2. The above employee has reported to our office on _________3. The official mails in the mailbox of outgoing official may be transferred to mail id of

_______________

Resignation / Retirement / Termination (As Applicable ): NOT APPLICABLE

1. The above employee has resigned / retired / his / her service has been terminated and will be relieved on _____________. The ID should be deleted within 30 days of acceptance of resignation / retirement or relieving date whichever is earlier.

2. The official mails in the mailbox of outgoing official may be transferred to the mailbox of

(Name of the authorizing authority)

DesignationDepartmentPlaceDate:

Form 10

Form 11

13

ID CARD FORMAT

Bran

Issued UTI Bank identity card replace with Axis Bank identity card

AXIS Bank Ltd.,Central Office, Mumbai.

Application form for issue of Identity card – New Joining Employee

Name :

Employee No :

Blood group :

Branch stamp

Branch Head / Department Head Sign Authorized signatory (Central Office HR/Zonal Office HR)

Stamp size photograph

On reversea) Employee No.b) stamp of branch

Annexure 1-To be retained by the employee

14

To All Employees:

September 19, 2002-

Code of Conduct for Prevention of Insider Trading

At the 61st Meeting of Board of Directors held on 10th July, 2002, the Board has approved a Code

of Conduct for Prevention of Insider Trading. This Code of Conduct is applicable to our Bank as

per the provisions of the Securities and Exchange Board of India - SEBI (Insider Trading)

Regulations, 1992 and Securities and Exchange Board of India - SEBI (Insider Trading)

(Amendment) Regulations, 2002 which have become effective from 20th February, 2002.

We give below the important provisions of the Code of Conduct for information and guidance of

all employees:

1. The purpose of this code is to comply with the Securities and Exchange Board of India - SEBI

(Insider Trading) Regulations, 2002 (SEBI code) dealing with:

a) Trading in the Bank’s securities listed on any stock exchange in India on the basis of any

unpublished price sensitive information;

b) Communicating any unpublished price sensitive information to any person except as

required under this regulation;

c) Counselling or procuring any person to deal in securities of any company on the basis of any

unpublished price sensitive information.

2. This Code covers all the directors of the Bank and all employees of the Bank, their dependent

family members (collectively referred to as "Insiders"), and any outsiders whom the

Compliance Officer may designate as Insiders as they have access to material information

which are otherwise not available in the public domain..

3. The Code applies to any transactions in the Bank's securities, including its ordinary shares,

options to purchase ordinary shares, convertible debentures/warrants, exchange-traded

derivative instruments and any other type of securities that the Bank may issue.

4. “designated employee” means all employees of the Bank in the grade of Vice President and

above and all employees in the Finance & Accounts department at Central Office, and at the

Registered Office of the Bank.

..1..

5. “Insider,” as defined under the SEBI Regulations, for our Bank shall cover and include all the

employees including the designated employees. Further, any person who was associated

with the Bank and who had access to price sensitive information shall also be deemed to be

an insider and shall be bound by these rules for the subsequent period of Six months.

15

6. The Statutory Auditors of the Bank are also considered as the “designated outsiders”.

7. “dealing in securities” means an act of subscribing, buying, selling or agreeing to subscribe,

buy, sell or deal in any securities by any person either as principal or agent.

8. “Securities” shall include shares, scrip, stocks, bonds, debentures or other marketable

securities of a like nature in or of the Bank.

9. “price sensitive information” means any information which relates directly or indirectly to a

company and which if published is likely to materially affect the price of securities of

company.

In simple terms, price sensitive information means information of any type, which could

reasonably expected to affect the price of the Bank’s securities, including but not limited to

the following:

i. periodical financial results of the Bank;

ii. intended declaration of dividends (both interim and final)/bonus/rights;

iii. issue of securities or buy-back of securities;

iv. any major expansion plans or execAXISon of new projects;

v. amalgamation, mergers or takeovers;

vi. disposal of the whole or substantial part of the undertaking;

vii. any significant changes in policies, plans or operations of the Bank;

viii. Private placement of securities;

ix. Significant change in any product related matters like R&D, supplies, inventory, price etc.

x. Management information reports;

xi. Significant change in the management;

xii. Any major labor dispute or major litigation

..2..

16

9A. The Company Secretary of the Bank has been designated as the Compliance Officer for the

purpose of this code.

10. A special “trading window” is approved by the Board and it means the period during which a

Director/ employee can trade in the securities of the Bank.

11. Any Director/designated employee willing to trade in securities of the Bank shall be required

to take a pre-clearance from the Compliance Officer if the person wishes to trade in securities

of the Bank atleast worth Rs.5 lacs or 5000 shares or 2% of the total shares of the Bank in a

month whichever is lower. For trading above 2000 and up to 5000 equity shares per month –

intimation within a week in a prescribed format to be made available to the Compliance

Officer but no pre-clearance required. No permission of or intimation to the Compliance

Officer will be required for trading up to 2000 equity shares per month.

A month shall mean a continuous period of 30 days from the last trade effected.

12. A Director/designated employee and/ or an insider shall hold their investments in securities

for a minimum period of 30 days in order to be consider as being held for investment

purpose.

13. The trading prohibitions and restrictions of this Code do not apply to exercise of options by

any director/designated employee and/ or insider under any Employee Stock Option Scheme

of the Bank. But trading prohibitions and restrictions of this Code apply to the sale of shares

acquired through the exercise of stock options granted by the Bank.

14.Violation of this Code or the Securities and Exchange Board of India (Prohibition of

Insider Trading) Regulations, 1992 by any director or employee and or insider

other than the employee, or their family members, may subject the director to

appropriate penal action and further the employee will be subject to disciplinary

action by the Bank which may include wage freeze, suspension, ineligibility for

future participation in Employee Stock Option Plans, etc. including termination

from service.

The action by the Bank shall not preclude SEBI from taking any action in case of violation of SEBI (prohibition of Insider Trading ) Regulations, 1992.

15. For any further clarification in this matter, you may contact the undersigned on email

[email protected] or phone no. 022-67074407

P. J. OzaCompany Secretary & Senior Vice President (Legal)

17

AXIS Bank Ltd.,

Code of Conduct for Prevention of Insider Trading

Do’s

1. Follow the provisions of the Code of Conduct for Prevention of Insider Trading.

2. Please note that the code applies to any transactions in AXIS Bank’s securities including its

Equity Shares and Convertible Debentures / Warrants and any other type of securities that

the Bank may issue.

3. Remember that ‘designated employee’ means all employees in the grade of Vice President

and above and all employees in the Finance and Accounts Department at Central Office and

all employees of the Registered Office of the Bank.

4. Please note that ‘insider’ definition shall cover all the employees of AXIS Bank

including the designated employees.

5. Please remember that ‘Price Sensitive Information’ means any information which relates

directly or indirectly to AXIS Bank and which if published is likely to materially effect the price

of Equity Shares of the Bank.

6. (I) Do take pre-clearance from the Compliance Officer if you are

a Director/designated employee and wish to trade in Equity Shares of the

Bank atleast worth Rs.5 lacs or 5000 Shares or 2% of the total shares of the Bank

in a month whichever is lower.

(II) Do intimate (no pre-clearance required) to the Compliance Officer within a week in

the prescribed format for trading above 2000 and upto 5000 Equity Shares per

month.

(III) No permission of or intimation to the Compliance Officer will be required for

trading up to 2000 Equity Shares per month.

7. Hold your investment in Equity Shares for a minimum period of 30 days in order to be

considered as being held for investment purpose.

8. Do remember that this code does not apply to exercise of options by any Director/designated

employee and/or insider under any Employee Stock Option Scheme of the Bank. However,

the trading prohibitions and restrictions of this code will apply to the sale of shares acquired

through the exercise of stock options granted by the Bank.

9. For a Director/designated employee of the Bank or any person holding more than 5% Shares

or voting rights in AXIS Bank, it is necessary to make initial/monthly/annual disclosure of

their holding in Equity Shares of AXIS Bank, as required under the code in the prescribed

format to the Compliance Officer.

Annexure 2-To be retained by the employee

18

AXIS Bank Ltd.,

Code of Conduct for Prevention of Insider Trading

Don’ts

1. (a) Do not trade in the Equity Shares of AXIS Bank listed on NSE/BSE/ASE on

the basis of any unpublished price sensitive information.

(b) Do not communicate any unpublished price sensitive information to

any person.

(c) Do not counsel or procure any person to deal in Equity Shares or other securities

of AXIS

Bank on the basis of any unpublished price sensitive information

2. Do not trade in Bank’s equity shares outside the applicable “trading windows” or

during any special trading blackout periods declared by the Compliance Officer.

3. Do not disclose to any outside third party that a special blackout-period has been designated.

4. Do not give trading advice concerning the AXIS Bank to third parties even when the you do

not possess material unpublished price sensitive information about the Bank.

5. (I) Do not forget to obtain pre-clearance from the Compliance Officer if

you are a Director/designated employee and wish to trade in Equity Shares

of AXIS Bank atleast worth Rs.5 lacs or 5000 Shares or 2% of the total shares of

the Bank in a month whichever is lower.

(II) Do not forget to intimate the Compliance Officer of the Bank if you are a

Director/designated employee and wish to trade in Equity Shares of AXIS Bank above

2000 but up to 5000 Equity Shares per month

6. Do not violate this code or the SEBI (Prohibition of Insider Trading) Regulations, 1992 as

violation may lead to disciplinary action by the Bank which may include wage freeze,

suspension, ineligibility for future participation in ESOPs including termination from service.

19

STATEMENTS OF ASSETS AND LIABILITIES FROM STAFF

An additional Rule No. 10.12 has been added under “Code of Conduct” in the Bank’s Staff

Rules as given below:-

10.12. Every officer on first appointment and as on 31 st March each year

(beginning with 31st March, 2003), shall submit a return of assets and liabilities

giving full details of:

a) the immovable property owned or acquired or held by the officer in

his/her name or in the name of any member of his / her family* or in the

name of any other person;

b) all financial securities and bank deposits including cash balances owned

or acquired or held by the officer;

c) debts and other liabilities incurred by the officer directly or indirectly,

including loans from the Bank.

* For the purpose of this Rule “ Family” means

i) Spouse, whether residing with the officer or not, but does not include a

legally separated spouse

ii) Children or step children or adopted children of the officer whether

residing with the officer or not and dependent wholly on such officer but does

not include children or step children of whose custody the officer has been

deprived of by or under any law; and

iii) Any other person related to, by blood or marriage to the officer or to the

officer’s spouse and wholly dependent upon such officer.

The Bank may also, at any time, by general or special order, require an officer

to furnish within a period to be specified in the order, a statement of moveable

or immoveable property owned, held or acquired by the officer or on the

officer’s behalf or by any member of the officer’s family as may be specified in

the order. Such a statement shall, if so required by the Bank include the details

of the means by which or the sources from which such property was acquired.

..2..

Annexure 3-To be retained by the employee

20

The above statement of Asset and Liabilities should be furnished in the

enclosed format on or before 30th June every year.

Non-submission of the above annual statements by officers would constitute an

act of misconduct under the Bank’s Staff Rules for which disciplinary action may

be taken by the Bank.

The contents of this circular may be brought to the notice of all officers in your department /

office. Soft copies of the forms are being sent to you separately. Officers posted in branches and

zonal offices should submit the form to their respective Zonal Heads. Zonal Heads and officers in

Central Office should submit their forms to the Senior Vice President, HR Department at Central

Office.

All the officers on the rolls of the Bank as on date must submit the first such statement as on 31 st

March, 2003 on or before 30th June, 2003.

S BhattacharyaPresidentHuman Resources

21

GROUP MEDICLAIM FLOATER POLICY

The Bank has obtained a Group Mediclaim Floater Policy from with M/s. ICICI Lombard

General Insurance Company Limited (Policy No. 4016/0003390/01/000) for facilitating the

hospitalisation benefit to the employees and their eligible dependants. The claim administration

process is managed by ‘I’-Health Care, an in-house claim administrator of M/s. ICICI Lombard

General Insurance Company. The current mediclaim policy will be in force from 1st October,

2009 to 30th September, 2010.

1. What is meant by “Floater’ concept in Group Floater Mediclaim Policy?

A limit is assigned to a family i.e. employee + 3 eligible dependents depending on the grade of the

employee. This limit can either be utilised by a single member or all the declared members together.

2. Who can be covered?

Wholly dependent Parents upto the age of 75 years (their age should not be more than 75 years at

the time of their inclusion under the policy).

Wholly Dependent Spouse

Wholly Dependent Children

Wholly Dependent Brothers and Sisters upto the age of 21 years.

The inclusion of dependants would be subject to approval by HR Department as per the norms mentioned

above.

3. What are the maximum coverage limits as per grade?

Vice President and above - 5.00 lacs

Assistant Vice President - 4.00 lacs

Manager/ Dy. Manager/ Executive/ Jr. Exe / BDE / BDO - 3.00 lacs

4. How does a newly joined employee include his dependants?

New employees joining the Bank are covered from the day of joining. However, they must

ensure to add the names of their dependants, by updating the dependants’ details on the

HRMS link http://hrms.axisb.com within a period of one month of joining. Please note that no

updation of dependants would be allowed after this period, during the policy year. The

details of self and the dependants (as approved by HR) would be reflected in the payroll site.

An intimation about rejection of dependants, if any, would be communicated to employees

through Lotus Notes.

5. How an existing employees can add the names of dependants?

Employees who had earlier declared less than 3 dependants can add the names of eligible dependants

only at the beginning of the policy year i.e. on 1st October every year. Thus, the employee must be

careful in including the names of their dependants on payroll site. However, subject to the availability

of a vacant slot, fresh inclusion during the policy year would be allowed only in following

circumstances:-

Parents retiring during the policy year and becoming wholly dependant on employee.

Annexure 3-To be retained by the employee

22

Employee gets married during the policy year and the spouse is wholly dependant on him.

Employee is blessed with a child during the policy year.

Employee wishes to replace a dependant who has expired during the policy year, with another

dependant.

6. When to replace the names of dependants?

Employee, who wishes to replace a name of one dependant in place of already covered and alive

dependant, can do so at the time of renewal of the policy only i.e. in the month of September after a

communication in this regards is sent from HR to all employees.

7. Which expenses are covered?

The policy facilitates reimbursement of hospitalisation expenses and related medical / surgical

treatment expenses incurred by an employee or his covered dependents, subject to the condition that

the hospitalisation is for more than 24 hours. Medical expenses incurred during a period upto 30 days

prior to hospitalisation and upto 60 days after hospitalisation can also be claimed as reimbursement.

Maternity benefit upto Rs. 50,000/- per delivery, during policy period of one year is covered. In

maternity pre and post natal are not reimbursed.

8. When hospitalisation for minimum period of 24 hours is waived?

For claiming reimbursement of expenses related to below mentioned illnesses, hospitalisation of more

than 24 hours is not required.

Dialysis

Chemotherapy

Radiotherapy

Eye surgery viz cataract, lazer surgery

Dental surgery arising out of accidental injury

Kidney stone removal

Tonsillectomy

9. Which expenses are not covered?

Bank’s Group Mediclaim Policy disallows re-imbursement of any expenses whatsoever incurred by an

employee or his dependant in connection with or in respect of:

Injury or diseases directly or indirectly caused by war, invasion, any foreign enemy or war like

operations

Cost of spectacles, lenses, hearing aids, dentures.

Dental treatment or surgery arising out of accidental injury.

Circumcision unless necessary for treatment of a disease not otherwise excluded or as may be

necessitated due to an accident, vaccination or inoculation or change of life or cosmetic or

aesthetic treatment of any description, plastic surgery other than as may be necessitated due to an

accident or as a part of any illness.

Convalescence, general debility, run-down condition or rest cure, congenital external disease or

defects or anomalies, sterility, venereal disease, intentional self- injury and use of intoxicating

drugs/alcohol.

All expenses arising out of any condition directly or indirectly caused to or associated with human

T-Cell Lymph Tropic Virus type III ( HT LB- III) or Lymphadinopathy Associated Virus (LAV) or the

23

Mutants Derivative or Variations Deficiency Syndrome or any Syndrome condition of a similar kind

commonly referred to as AIDS.

Charges incurred at hospital or nursing home primarily for diagnostic, X-ray or laboratory

examinations or other diagnostic studies not consistent with or incidental to the diagnosis and

treatment of the positive existence or presence of any ailment, sickness or injury for which

confinement is required at a hospital or nursing home.

Expenses on vitamins & tonic unless forming part of treatment for injury or disease as certified by

the attending physician.

Injury or disease directly or indirectly caused by or contributed to by nuclear weapons / materials,

chemical warfare.

Naturopathy treatment.

Expenses incurred under domiciliary hopsitalisation.

Hospitalisation for conducting the pathological / medical test.

10. Which expenses are payable under maternity?

The policy allows re-imbursement of expenses related to Maternity without any waiting period.

Only expenses incurred during the period of hospitalisation i.e. from date of admission to date of

discharge are reimbursed.

Pre and post natal expenses are not reimbursed.

Can be claimed for ‘first two children’ only

Maximum amount can be claimed is Rs. 50000/-

11. What are features available on I-Healthcare i.e. the claim administrator’s link?

'I' platform of 'I'-Health Care

Employees can access 'I' platform of 'I' Health Care by clicking on the link http://24x7.icicilombard.com/ghi/iHealthCare/icare_wfrm_login.aspx. The link will take you to the home page of 'I' Health Care where following two facilities are available:

1. 'I'-Services log-in

'I' Services Log-in will facilitate generation of e-cards, checking the policy and claim status online.

Where the login ID is asked employees have to enter his/her Employee Number in the text box and where Password is asked the employee will enter “axis” and DOB (ddmmyyyy format) e.g.: axis06121983 and click the submit button. It will take you to a page where you will find three options:

a. Policy details

b. Enrollment details

c. Claim Status

d. Print I card

a. Policy details :

By selecting this option and clicking submit button, Employees can get the policy details.

b. Enrollment details :

24

By selecting this option and clicking submit button, Employees can access details of all his enrolled dependent family members.

c. Claim Status :

By selecting this option and clicking submit button, Employees can access details of claim/s lodged by them.

d. Print I card

Employees will be able to access his / her dependants’ e-cards and will able to view options as under:

Print E-card

By clicking this button, employees can take print of e-cards. However, it is recommended that employees should not print this e-card as this e-card will not have details of Policy no., Gender, Employee ID of Axis Bank. These details are available in the next option.

Customised E-card

By clicking this button, employees will be able to see three buttons namely policy no., gender and employee no.. Employees are requested to select all options and then click on select button. Now E-card will appear with Company Name, Name, Age, Gender, Card No., Policy No., Employee ID, Valid from and Valid to.

Employees are requested to take a print of their e-cards by clicking on Print E-card button.

Family E-card

By clicking this button employees will be able to view the names of their registered dependants. Employees have to select name of one dependant at a time and click on select button. Employees will be able to view E-cards of the selected dependants. They can print these cards by clicking print button.

The employees who have not declared any dependants will not get the option of Family E-card.

2. 'I'-Library.

The 'I'-Library service would facilitate downloading of following:

The process to be followed for cashless hospitalisation and reimbursement of claims. Pre-authorisation form Claim form and Network Hospital List

12. How to use the cashless facility?

You can utilise this facility only in those hospitals, which are empanelled with ICICI Lombard General Insurance Co. Ltd. For utilising the cashless facility you have to fill up the pre-authorisation form available with the hospitals.

Part I : This has to be filled up by the employee and it consists of following details: Policy No. : 4016/0003390/00/000 E-cardNo : which is available on below site.

http://24x7.icicilombard.com/ghi/iHealthCare/icare_wfrm_login.aspx

Part II : This has to be filled by treating doctor / hospital and it consists of following details: Nature of illness Nature of treatment to be given Probable stay in hospital Estimated expenses (with break-up) to be incurred etc. Detailed line of treatment

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After filling the above details, the hospital (may be advised) to fax the pre – authorization form to ‘I’-Health Care on the toll free fax no. 1800 209 8880. I – Health Care will scrutinise the request at its end and then communicate the approval to both i.e the hospital and the patient (by SMS if mobile number is mentioned on pre-authorisation form).

13. What is the Claim Procedure for reimbursement of medical expenses?

After discharge from the hospital a reimbursement claim form (copy available on ‘I’-Health Care and

Payroll-site) should be submitted within 30 days along with the original documents to ICICI Lombard at

the address mentioned below:

ICICI Lombard General Insurance Company Ltd,

'I'-Health Care,

TGV Mansions,

6th floor, Khairatabad,

Hyderabad 500004

14. Documents to be submitted in original alongwith the reimbursement claim.

Claim Form duely filled

Discharge Card

Hospital Bill

Hospital Receipt

Diagnostic and Test Reports

Prescriptions and Consultation Letters

Chemists /medicine/ diagnostic bills and receipts

15.Toll free 24 x 7 call centre assistance:

For any query related to pre-authorisation approval for hospitalisation, claim submission,

features of policy etc. the employees may contact the 'I' - Health Care on the Toll Free Call

Centre No: 1800 209 8888 (this number is accessible even from a mobile phone).

15.Escalation Matrix:

• For any issue related to claim servicing the employees may get in touch with following official

of 'I'- Health Care:

Shri Pradman Saluja - [email protected] • For any service related issue/greivance the employees may get in touch with the following

official from ICICI Lombard :

Shri Pradman Saluja - [email protected] • Apart from this the employees may also reach following officials from our Human Resources

Department

Level 1. Mr. Gitesh Kadam on mail id [email protected] or on – 022 -

6627 7244

Level 2. Mr. Sachin Chavan mail id [email protected] or on 022 - 6627

7241

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Reimbursement Claims1. Main hospitalization claims documents should be submitted within 30 days from date of

discharge.2. Post hospitalization claim can be submitted within 90 days from date of discharge or 30

days from date of end of treatment whichever is earlier3. Please ensure that claim form is filled properly and signed. Please also do not forget to

mention the UHID on claim form along with your latest mobile no. 4. In some cases indoor case papers might be required hence it is advisable that a copy of

indoor case papers is collected at the time of discharge from the hospital.5. Please ensure that following documents are submitted in original along with the claim

form:a. Original Discharge card mentioning date of admission, date of discharge,

investigations done, findings, detailed line of treatmentb. Original bills & paid receiptc. Bills & paid receipt should be supported by:

i. Medicine bills,ii. Prescriptions for medicinesiii. Original Investigation reports

Cashless Claims1. For planned hospitalization it is recommended that cashless approval is taken one day

prior to hospitalization2. Please ensure that pre authorization form has correct UHID along with the updated

mobile no.3. Please note that stand alone investigation/ diagnostic procedure for evaluation is not

covered under the policy.4. Once the fax is sent, it is advisable to confirm the receipt of the same from iHealthcare

call centre5. If a revert is not received in 4-5 hours from the time of confirmation of fax receipt, please

get in touch with HR team who in turn will ensure co-ordination with ICICI Lombard.6. Please also note that initial approval from insurance company comes for a part of the

estimated cost of treatment, which will be enhanced as per the progress in the treatment based on the progress report provided by the hospital to iHealthcare.

Toll Free Call Center No.: 1800 209 8888Toll Free Fax No. : 1800 209 8880

Address for sending the reimbursement claims:

ICICI Lombard General Insurance Company,i Health Care,TGV Mansions,6th floor, Khairatabad, Hyderabad - 500004

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