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    Amit Rai PDF

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    thirumala_hema3517
    This document is a schedule of travel insurance issued in Mumbai for Mr. Amit Kumar Rai. It provides insurance coverage for his travel from February 25, 2015 to March 17, 2015. The premium paid is INR 1,138. The policy covers various benefits like accidental death, medical expenses, evacuation, baggage delay, and liability. It lists the maximum coverage amounts and deductibles for each benefit. Contact information is provided for claims assistance. Certain sub-limits apply to medical expenses for insured persons aged 56 and above.

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    © All Rights Reserved
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    Amit Rai PDF

    Uploaded by

    thirumala_hema3517
    177 views2 pages
    This document is a schedule of travel insurance issued in Mumbai for Mr. Amit Kumar Rai. It provides insurance coverage for his travel from February 25, 2015 to March 17, 2015. The premium paid is INR 1,138. The policy covers various benefits like accidental death, medical expenses, evacuation, baggage delay, and liability. It lists the maximum coverage amounts and deductibles for each benefit. Contact information is provided for claims assistance. Certain sub-limits apply to medical expenses for insured persons aged 56 and above.

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    This document is a schedule of travel insurance issued in Mumbai for Mr. Amit Kumar Rai. It provides insurance coverage for his travel from February 25, 2015 to March 17, 2015. The premium paid is INR 1,138. The policy covers various benefits like accidental death, medical expenses, evacuation, baggage delay, and liability. It lists the maximum coverage amounts and deductibles for each benefit. Contact information is provided for claims assistance. Certain sub-limits apply to medical expenses for insured persons aged 56 and above.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    177 views2 pages

    Amit Rai PDF

    Uploaded by

    thirumala_hema3517
    This document is a schedule of travel insurance issued in Mumbai for Mr. Amit Kumar Rai. It provides insurance coverage for his travel from February 25, 2015 to March 17, 2015. The premium paid is INR 1,138. The policy covers various benefits like accidental death, medical expenses, evacuation, baggage delay, and liability. It lists the maximum coverage amounts and deductibles for each benefit. Contact information is provided for claims assistance. Certain sub-limits apply to medical expenses for insured persons aged 56 and above.

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    © All Rights Reserved
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    Schedule of Travel Insurance

    IssuedatMumbai

    11/02/2015
    0009455065-030001

    WorldwideExcludingAmericas

    Date Issued:
    Producer Code:
    Applicant Phone No:

    Travel Dates:

    From: 25/02/2015

    Applicant Name:

    MrAMITKUMARRAI

    Duration:

    21Days

    Schedule Number:
    Insurance Plan:
    Zone:

    PC793760
    TravelGuardSilverPlus
    To: 17/03/2015

    7382654769

    Applicant Address: FLAT NO 103 SAI RAM RESIDENCY FRIENDS COLONY MIYAPUR N HYDERABAD SHANKAR NETRALAYA
    500049
    PREMIUM
    Premium

    INR

    1013.00

    Tax(12.36%)

    INR

    TOTAL PREMIUM

    INR

    125.00
    1138.00

    IMPORTANT:AnyPre-ExistingMedicalcondition/Ailmentsdeclaredor
    undeclaredwillbeexcludedfromthepolicy.TheCoverageprovidedis
    subjecttothedetailsanddeclarationmadeintheproposaltothe
    companyandattachedPolicyWording.
    MAXIMUM COVERAGE

    BENEFITS
    AccidentalDeathandDismembermentBenefit(24hrs)
    AccidentalDeathandDismembermentBenefit(CommonCarrier)
    Accident&SicknessMedicalExpenseReimbursement
    SicknessDentalRelief
    EmergencyMedicalEvacuationBenefit
    RepatriationofRemains
    BaggageDelayBenefit(Afterfirst12hrs.)
    CheckedBaggageLossBenefit
    LossofPassportBenefit
    PersonnalLiabilityBenefit
    FlightDelay
    Hijack
    Automaticextensionofpolicyupto7days
    Emergencycashadvance
    FraudulentCharges(PaymentCardSecurity)
    HomeBurglary(InRs.)
    TripCancellation

    DEDUCTIBLE

    $10,000
    $5,000
    $100,000
    $400

    $100
    $150

    Included*
    Included*
    $100
    $750
    $250
    $150,000
    $100($10per12Hrs)

    $30
    $200
    12Hrs

    $500($100perDay)
    Available
    $750
    $500
    Rs.100,000
    $500

    1Day

    $50

    TripCurtailment
    $500
    $50
    MissedConnection/Misseddeparture
    $500
    $50
    Bouncedhotel/Airlinebooking
    $500
    $50
    NOTES
    *IncludedundertheoveralllimitofAccident&ServicesMedicalExpensesReimbursement.
    Underannualmulti-trip,entryageisupto70years.Renewalsare applicablebeyond71years andpolicytermsandconditions
    shallcommenceonlyincaseofrenewals.
    Noticeofamedicalcondition/eventmustbeprovidedtoyourassistancecontact(seebelow)attimeofcareorassoonaspossible
    after emergency care; failureto do so may affect benefitsand coverage. For details on sublimitsfor insured 56 years of age
    pleaseseethenextpageofthispolicyscheduleorrefertothepolicywordingsscheduleofbenefitPartGsuppliedalongwiththis
    schedule.
    Insured# InsuredName
    1

    MrAMITKUMARRAI

    PassportNumber
    F5919822

    DateofBirth
    10/08/1981

    Assignee
    VANDANARAI

    #Thebenefitsmentionedinthistableareapplicableforeverysingleinsuredindividuallycoveredunderthispolicy.
    Signedfor&onBehalfofTataAIGGeneralInsuranceCompanyLtd.

    Agent/BrokerName:Tata

    Aig
    Agent/BrokerLicenseCode:NA
    Agent/BrokerContactNo:18002667780

    Declaration:
    I/WeherebydeclareandstatethatallstatementsandinformationfurnishedintheProposaltothe
    companyandascapturedintheabovescheduleofInsurancearetrueandcomplete.Iffoundthat
    thesaidstatementsandinformationfurnished/statedisincorrectoruntrueinanyrespectormanner
    whatsoever,IagreeandacknowledgethattheInsurancecompanyshallnotbeliableinanymanner
    whatsoeverinrespectoftheinsurancecoverageunderthispolicy.

    InsuranceStampDutyPaid:Rs.1/-videreceipt/ChallanNo.MH001559912201314Edated11thFebruary2014

    SignatureoftheInsured/Proposer:

    Tata AIG General Insurance Company Limited


    Registered Office: Peninsula Business Park, Tower A, 15th Floor, G.K. Marg, Lower Parel, Mumbai - 400013.
    IRDA Regn. No. 108. CIN - U85110MH2000PLC128425
    www.tataaiginsurance.in Toll free Helpline 1800-266-7780 Email: [email protected]

    Schedule of Travel Insurance


    IssuedatMumbai

    11/02/2015
    0009455065-030001

    WorldwideExcludingAmericas

    Date Issued:
    Producer Code:
    Applicant Phone No:

    Travel Dates:

    From: 25/02/2015

    Applicant Name:

    MrAMITKUMARRAI

    Duration:

    21Days

    Schedule Number:
    Insurance Plan:
    Zone:

    PC793760
    TravelGuardSilverPlus
    To: 17/03/2015

    7382654769

    Applicant Address: FLAT NO 103 SAI RAM RESIDENCY FRIENDS COLONY MIYAPUR N HYDERABAD SHANKAR NETRALAYA
    500049

    Address for Claim/US Non Medical


    (For Insureds only)

    Assistant Contact (For Insureds only)

    Claims Department

    For excluding the Americas Policies:

    Tata AIG General Insurance company Ltd.

    Call:+603-8991-2012or+603-8991-2014
    (TollWorldwide)
    Email(assistance):
    [email protected]

    5 th

    A-501,
    Floor, Building No. 4, Infinity Park,
    Gen. A. K. Vaidya Marg, Dindoshi, Malad (E),
    Mumbai, India - 400 097.
    Visitourwebsite:www.tataaiginsurance.in OR Email
    [email protected] OR Callour24x7
    tollfreehelpline1800-266-7780(Accessiblefromall
    lines)
    OR1800-11-9966(AccessiblefromBSNL/MTNLLines)

    For the Americas Policies:


    PleaseCall:+1-866-866-2619(TollFreewithinUS&
    Canada)+1-817-826-7017(ReverseCharge/Collect
    fromotherplaces)
    Email:[email protected]

    US Medical Claims (For Providers Only)


    PlanType:
    PolicyCertificate#:
    Mail Medical Claims to:

    Shared Savings

    LTA
    PC793760

    TravelGuard
    Attn:TataAIGClaims
    POBox8003
    StevensPoint,WI54481

    Sub-limits :
    The following Maximum eligible expenses per Disease/Illness are automatically applicable to Insured Persons aged 56 years
    onwards, regardless of the plan/option purchased at the inception/its subsequent renewals if applicable.
    Sublimits can be waived off by payment of additional premium. If waived then this will appear in Insurance Plan on Page 1.
    The maximum limit would be as mentioned below or upto the Sum insured whichever is lower.
    I. Hospital Room Rent, Board and Hospital misc. maximum $1500 per day up to 30 days.
    II. Intensive Care Unit-Maximum $3000 per day up to 7 days.
    III. Surgical Treatment-Maximum USD $10000
    IV. Anesthetist Services-Maximum up to 25% of Surgical treatment
    V. Physician's Visit-Maximum $75 per day up to 10 visits.
    VI. Diagnostic and Pre-admission testing-Maximum up to $ 500
    VII. Ambulance Services-Maximum up to $ 400.

    Signedfor&onBehalfofTataAIGGeneralInsuranceCompanyLtd.

    Tata AIG General Insurance Company Limited


    Registered Office: Peninsula Business Park, Tower A, 15th Floor, G.K. Marg, Lower Parel, Mumbai - 400013.
    IRDA Regn. No. 108. CIN - U85110MH2000PLC128425
    www.tataaiginsurance.in Toll free Helpline 1800-266-7780 Email: [email protected]

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