*4015224*

Bajaj Allianz General Insurance Company Ltd.

Regd.Office - GE Plaza, Airport Road, Yerwada, Pune - 411006 (India)
TRAVEL COMPANION IDENTIFICATION AND SCHEDULE
Reference No : Y
Policy No : OG-11-1529-9910-00000033 Imdcode : 10018473
Insurance Plan Chosen : TRAVELCARE Subcode:
Proposer Name : DHANASEKAR G Partner Id: 33908762
Date Of Birth: 23-SEP-1976 Geographical Coverage : IncludingUSA
Home Address : ADDRESS 2 ADDRESS 1 KRISHNAGIRI TN
Pincode : 600049 Telephone Nos :
Passport No : SAFF2314125 Assignee : Prakash
BENEFITS Limits (Max for entire policy period) DEDUCTIBLE
Medical Expenses, Evacuation and Repatriation of Remains (Max. limit for USD 50000 USD 100
Emergency dental Treatment is USD 500 (included in Medical Expenses))
Emergency Cash Advance USD 500 NIL
Personal Liability USD 100000 USD 100
Hijack $ 50 per day max $300 NIL
Loss Of Passport USD 250 USD 15
Personal Accident USD 10000 NIL
loss of checked baggage (Max liability per baggage is 50% of the limit and max USD 250 NIL
liability per item in a baggage is 10% of the limit as mentioned in the Schedule)
Delay of Checked Baggage USD 100 12 hrs
Base Premium (in Rupees) : 1110
Service Tax (in Rupees) : 111
Edu Cess (in Rupees) : 3
Total Premium (in Rupees) : 1224
Date of Purchase of Policy : 17-APR-2010
Policy Period : From 21-APR-2010 to 13-MAY-2010 Or Date of return of Insured.

Claims Assistance Department : Health Administration Team

24 hours Helpline : Telephone No +91 20 3030 5858,Fax No: +91 20 3051 2207
Email : travel@bajajallianz.co.in
Address of Notification of Claims : Bajaj Allianz General Insurance Company Limited,
Ground Floor, Ashoka Plaza, 32/2, Nagar Road, Nr. Weikfield Company, Pune 411014
IMPORTANT : The policy coverages are as per the policy terms and conditions mentioned in the Travel Kit provided with this policy schedule.
You may refer the same on our website as well. Always and COMPULSORILY first contact the 24 hours helpline and obtain prior notification
number from HELP LINE before incurring any expense. For all claims Please quote the claims notification number and submit claim forms with
original medical bills. The coverage provided is subject to details and declaration in the proposal form given prior to taking this policy and
attached policy wordings.
Extension Process :
In case of any claim, please contact our 24 Hour Call centre at 1600-22-5858,1800-22-5858, 1800-102-5858,1800-209-5959 (Toll Free) /
91-020-30305858 (chargeable, add area code before this number in case of mobile call) or email us at 'info@bajajallianz.co.in'.
For any claim or policy related queries, please call us at +91 20 3030 5858(chargeable) or Toll Free Nos. mentioned on the travel kit. Alternately
you may mail us your query at travel@bajajallianz.co.in.

For & Behalf of Bajaj Allianz General Insurance Company Ltd.

Stamp
Duty
Rs. 0.5

Authorized Signatory
QC signed and verified Consolidated stamp Duty paid vide Receipt No: .40472 dated
28-JAN-10
Regd Office : GE Plaza,Airport Road, Yerwada Pune-411006 (India)
ReceiptNo / Collection No / Amt(INR) := 1529-00048365/1/1224(INR) (If Premium is paid through cheque the policy is void ab-initio in case of dishonor of
chq.)
Declaration by the insured : We understand that this policy has been issued based on the information provided by us/our representative
and the policy is not valid if any of the information provided is incorrect. We also understand that this policy does not cover any pre-existing
illness or disability or conditions arising therefrom.

Policy is valid only if countersigned by the insured in the space above Signature of Insured
accepting this declaration

Service Tax Reg. No. : AABCB5730G-ST-001

" Terms, Conditions and exclusions as per applicable memos and policy clause attached"