120 lines
5.8 KiB
PHP
Executable File
120 lines
5.8 KiB
PHP
Executable File
<body>
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<div style="display: flex;justify-content: center;gap: 10px; width:840px;margin:0 auto 15px; page-break-after: auto;">
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<div style="border: 1px solid black;width: 400px;max-height: 300px;background: url('{FRONT_CARD}');background-size: 100% 100%;padding: 10px;">
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<div style="display: flex;">
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<div><img src="{INSURER_LOGO}" alt="" width="60px"
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width="60px" style="object-fit: fill;;"></div>
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<div style="text-align: center;font-family: sans-serif;font-weight: 600;margin-top: 10px;"><span>THE NEW
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INDIA ASSURANCE CO.LTD.</span> <br><span style="font-size: 15px;">GOOD HEALTH MEDICLAIM
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POLICY</span></div>
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</div>
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<table data-custom-table-css="table"
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style="font-family: sans-serif;font-size: 14px;width: 100%;margin-top: 20px;margin-left: 20px;line-height: 20px;">
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<tbody>
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<tr>
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<td>MDID : {TPA_ID}</td>
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</tr>
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<tr>
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<td colspan="2"><b>{NAME}</b></td>
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</tr>
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<tr>
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<td>Certificate No : {UHID}</td>
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</tr>
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<tr>
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<td><span>Sex : {GENDER} </span> <span style="margin-left: 30px;"> Date of Birth : {DOB}</span>
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</td>
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</tr>
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<tr>
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<td colspan="2"><b>{SELF_NAME}</b></td>
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</tr>
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<tr>
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<td>Valid form :{POLICY_DATE}</td>
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</tr>
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</tbody>
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</table>
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</div>
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<div style="border: 1px solid black;width: 400px;max-height: 300px;padding: 5px;">
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<div style="font-size: 11px;text-align: center;">The card is for identification purpose only</div>
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<table data-custom-table-css="table" style="width: 100%;text-align: center;font-size: 11px;">
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<tbody>
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<tr>
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<td>General & Claim Enquiry Helpline</td>
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<td>Cashless Enquiry helpline</td>
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</tr>
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</tbody>
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</table>
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<table data-custom-table-css="table" style="font-size: 11px;width: 100%;text-align: center;">
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<tbody>
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<tr>
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<td style="border: 1px solid black;">Toll Free : 1800-209-7777 <br>Email :
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citibank_chennai@mdindia.com</td>
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<td style="border: 1px solid black;">Toll Free : 1800-209-7800 <br>Email:
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authorisation@mdindia.com</td>
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</tr>
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</tbody>
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</table>
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<div style="font-size: 14px;text-align: center;">CITI MDIndia branch contact</div>
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<div>
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<table data-custom-table-css="table" style="text-align: center;width: 100%;font-size: 12px;">
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<thead>
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<tr>
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<th style="border: 1px solid black;">Center</th>
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<th style="border: 1px solid black;">Ph.No/Fax.No.</th>
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<th style="border: 1px solid black;">Center</th>
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<th style="border: 1px solid black;">Ph.No/Fax.No.</th>
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</tr>
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</thead>
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<tbody>
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<tr>
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<td style="border: 1px solid black;">Chennai</td>
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<td style="border: 1px solid black;">9381819401</td>
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<td style="border: 1px solid black;">Delhi</td>
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<td style="border: 1px solid black;">9310596976</td>
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</tr>
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<tr>
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<td style="border: 1px solid black;">Chennai</td>
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<td style="border: 1px solid black;">9381819501</td>
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<td style="border: 1px solid black;">Mumbai</td>
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<td style="border: 1px solid black;">9320373542</td>
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</tr>
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<tr>
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<td style="border: 1px solid black;">Hyderabad</td>
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<td style="border: 1px solid black;">9390838023</td>
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<td style="border: 1px solid black;">Pune</td>
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<td style="border: 1px solid black;">9371644536</td>
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</tr>
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<tr>
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<td style="border: 1px solid black;">Bangalore</td>
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<td style="border: 1px solid black;">9341555665</td>
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<td style="border: 1px solid black;">Kolkata</td>
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<td style="border: 1px solid black;">9333441389</td>
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</tr>
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</tbody>
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</table>
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</div>
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<div>
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<h6 style="margin: 5px;">TERMS AND CONDITIONS</h6>
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<ol style="font-size: 11px;padding-left: 15px;margin-top: 0px;">
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<li>Pre authorisation is compulsary from tpa prior to planned admission within 24hours for
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emergencies.</li>
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<li>Admission for Investigation/Evaluation Not covered.</li>
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<li>All terms and conditions of the policy would be applicable</li>
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<li>cashless hospitalisation in network hospitals can be obtained in conjunction with this card.an
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authorisation letter issued by tpa and photo identification and such as Voters ID,Driver
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Licence,Passport,etc.</li>
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</ol>
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</div>
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</div>
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</div>
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</body>
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