You are on page 1of 2

Certificate - Reliance Travel Care Insurance Policy

Policy Issuing Office :
Reliance General Insurance Company Ltd. 570, Rectifier House, Naigaum
Cross Road, Wadala (W), Mumbai, Maharastra - 400 031.

Policy Servicing Office Name & Address NEHRU PLACE I
Plot No-60, Okhla Industrial Estate Phase-III, Opp. SBI, New Delhi - 110020, New
Delhi, Delhi, Delhi - 110020 Phone No. : 011 30913560

Certificate No. -

Master Policy No. -

Br. Code-

1305952822155530

856086-13050

PSO No. -

Details of the Insured
Name of the Insured
Address of the Insured
Details of the Insured Person
Name of the Insured Person

GOFLIIOS1A6FA143 Dept. 7289017

9202932822000032

OVERSEAS

Intermediary Code -

Direct

IBIBO WEB PRIVATE LIMITED
F-130, GF, STREET NO.7, PANDAV NAGAR, DELHI-110091

Date of Birth

Passport No.

Gender

Nominee Name

Relationship of the
Nominee with the Insured
Person

SIDDHARTH SANJAY DAREKAR
Address of Insured Person

24-Mar-1992
L5658178
MALE
SUPRIYA DAREKAR
MOTHER
IBIBO WEB PRIVATE LIMITED, 5TH FLOOR, GOOD EARTH CITY CENTRE, SECTOR 50, GURGAON, HARYANA - 122018

E mail id
Telephone Number
Geographical Coverage
Country Visiting

SIDDHARTH.DAREKAR@YAHOO.CO.IN
8446458059

Policy Period

From

Name of the Plan opted

IBIBO WEB- EXCLUDING USA & CANADA

CZECH REPUBLIC

Any Pre existing disease

17-Sep-2015

to

19-Sep-2015

3 Days

NO

POLICY COVERAGE

Sum Insured ( in USD )

Medical Expenses (Including Evacuation / Repatriation including transport of the mortal
remains or burial at the place of death abroad)
Dental Care Expenses
Loss of Passport
Total Loss of Checked Baggage
Delay of Checked baggage
Personal Accident
Accidental Death
Personal Liability
Daily Allowance in case of Hospitalization
Financial Emergency Assistance
Hijack Distress Allowance
Trip Delay (12 hours and more)
Trip Cancellation and Interruption
Missed Connection
#Limits of Indemnity
Any one illness***
Any one Accident***
*** IS APPLICABLE ONLY FOR PEOPLE IN THE AGE GROUP OF 61 TO 70

Deductible ( in USD )

2,50,000

50

500
300
1,000
125
25,000
5,000
2,00,000
25 per day ( 6 days max)
1000
75 per day (7 days max)
50 per day (6 days max)
1000
300

50
25
NIL
12 hrs
NIL
NIL
NIL
2 days
NIL
12 hrs
12 hrs
NIL
NIL

15000
30000

#Warranted that:
a. Policy to be issued to the customers who is the citizen of republic of India and having permanent place of residence in India. Policy cannot be issued to NRI or
foreign nationals.
b. The insured person has no past history of any illness/hospitalization.
c. Per baggage maximum 50% and per item in baggage max 10%
d. In case of financial emergency occurring in Asian Countries the maximum sum insured applicable would be USD 300.
e. Warranted that any medical expenses incurred during the period of insurance which arise out of any preexisting disease condition shall be admissible only if it
is related to any life threatening condition and such payment shall be restricted to US $10,000/- per insured person subject to sum insured.
f. For age below or 60 years the limit of liability of the company should be restricted to US $1,00,000 per illness/disease/accident sustained or contracted within
the period of insurance whilst on the trip abroad that may lead to one or more medical expenses and/or hospitalization expenses.
g. Coverage is applicable for the trip, subject to first departure is from India and the policy is in force before commencement of the journey from India.
h. At the time of any incident causing claim sufficient documentary proof (passport copy) confirming age of the insured person should be submitted.
i. For details on coverage, exclusion, terms and conditions this certificate should be read with master policy issued to goibibo vide policy no. 9202942822000027
j. The policy is issued based on the declaration that you are not suffering from any pre-existing condition/disease/illness/injury.
k. Personal liability - per incidence limited to USD 25,000
Net Premium:
Service Tax(10% of Net Premium);
Edu Cess(2%of Service Tax):
High Edu Cess(1% of service Tax):
Total Premium:
In witness whereof this policy has been signed at Mumbai on

Rs. 181.56
Rs.25.42
Rs.0.00
Rs.0.00
Rs.207.00
: 19-Jul-2015

Subject to the terms, conditions and exclusions of the Reliance Travel Care Insurance Policy issued vide Master Policy indicated above.
*per baggage maximum 50% and per item in baggage max 10%.
For and on behalf of Reliance General Insurance Company Limited.

Service Tax Registration No. : AABCR6747BST001
Category-General Insurance Business Service 00440005
Consolidated Stamp duty Paid vide Receipt No. MH006126164201415E dated : 02.03.15**

Authorized Signatory

** Not applicable for Jammu and Kashmir State.
** In case of financial emergency occuring in Asian countries, the maximum Sum Insured applicable would be 300 USD

The policy has been issued based on the information provided by you/ your representative and the policy is not valid if any of the information provided is
incorrect. Subject otherwise to the terms, conditions and exclusions of the Reliance Travel Care Insurance Policy. Medical Assistance & Emergency services are
implemented by our service provider.
Medical Assistance & Emergency Services are provided by our Service Provider, Europ Assistance who are at your Service 24*7 during trip duration.
Registered Office: - Reliance Centre, 9, Walchand Hirachand Marg, Ballard Estate, Mumbai – 400 038. RGI call center Pan India 1800 3009 (toll free)

014 800 10101022. Australia – 0011 800 10101022. 001010 800 10101022.Reliance Centre. C-301. 9. Japan . Ballard Estate. Business Square. USA – 8774714686. Mumbai . Andheri(E). New Zealand. In case of any requirement for emergency assistance whilst abroad.in Website: www. please contact the toll free helpline numbers given below: International Toll Free line : Singapore. Spain. Chakala.EUROP ASSISTANCE INDIA PVT.0033010 800 10101022. Poland. Portugal. Malaysia. Taiwan. Denmark. Israel . Switzerland . South Africa – 09 800 10101022 and for the following countries. Andheri-Kurla Road.europ-assistance. RGI call center Pan India 1800 3009 (toll free) . Please contact the International Toll Free Helpline numbers given below. Germany. Austria. Sweden. Norway. Belgium.400 093. Thailand. LTD. Mumbai – 400 038. Walchand Hirachand Marg.Netherlands. Czech Republic. INDIA Please provide Immediate intimation of any claim / requirement for emergency assistance while abroad to ensure that the Claim is not prejudiced.00 800 10101022 Dedicated National Toll Free Help Line : 1800 209 5522 Land Line : +91 22 67347843 & +91 22 67347844 Email : reliance@europ-assistance.com Fax Number: +91 22 67347888 Intermediary Code/Name : Direct Registered Office: . Greece. Canada – 8776266511. Italy. France. Hungary. United Kingdom. Hongkong is 001 800 10101022. China.