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IssuedatMumbai
10/02/2015
0009455065-030001
WorldwideExcludingAmericas
Date Issued:
Producer Code:
Applicant Phone No:
Travel Dates:
From: 25/02/2015
Applicant Name:
MrANILKUMARKATAKAM
Duration:
21Days
Schedule Number:
Insurance Plan:
Zone:
JR673871
TravelGuardSilverPlus
To: 17/03/2015
9849006061
INR
1125.00
Tax(12.36%)
INR
TOTAL PREMIUM
INR
139.00
1264.00
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
MrANILKUMARKATAKAM
PassportNumber
J2218551
DateofBirth
10/04/1966
Assignee
MANJULAKATAKAM
#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:
10/02/2015
0009455065-030001
WorldwideExcludingAmericas
Date Issued:
Producer Code:
Applicant Phone No:
Travel Dates:
From: 25/02/2015
Applicant Name:
MrANILKUMARKATAKAM
Duration:
21Days
Schedule Number:
Insurance Plan:
Zone:
JR673871
TravelGuardSilverPlus
To: 17/03/2015
9849006061
Claims Department
Call:+603-8991-2012or+603-8991-2014
(TollWorldwide)
Email(assistance):
TGAP.TATAmedical@travelguard.com
Shared Savings
LTA
JR673871
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.