Signed

by:Mr.Anand
Singhi
Date:2017.03.10

RELIANCE TRAVEL CARE INSURANCE-CORPORATE FLEXI CERTIFICATE

Policy Issuing Office : Policy Servicing Office Address :
Reliance Centre, 4 Floor, South Wing, Near Prabhat Colony, Santacruz (East), Mumbai - 400 No.1-89/3/B/40 to 42/KS/301 3rd floor, Krishe sapphire, Madhapur, Hyderabad , HYDERABAD, TELANGANA,
055 INDIA,PinCode-500081. Contact No.040-39838550
Certificate Number:181651728320113205 Master Policy Number: 9202562832M00005
Details of the Insured
Name of the Proposer : CYIENT LTD Tel./Mobile No:
Adress :Plot No-11, Software Units Layout,Madhapur, Hyderbad-500081, E-mail ID: kruthartha.ravi@cyient.com
Details of the Insured Person
Name : SIVARAMAN KUMAR Date Of Birth:22/02/1993 Gender : M Passport No:M2741543
Nominee Name:CYIENT LTD Relationship with Nominee:Employer
Address of Insured Person: 4th Floor, A wing, Plot No.11, Soft,Info City, Madhapur,Hyderabad-500081,HYDERABAD - ,Andhra Pradesh,India
Landline Number: Mobile No: 9003785953 E-mail ID:
This Policy is valid From 00:00 hour on : 13-Mar-2017 To 10-Jun-2017 midnight Number of Travel Days:90
Period of Insurance: The period of Insurance in respect of individual Insured Person covered would be as per the certificate issued. The period of insurance is from the commencement of
insurance cover to the end of the insurance cover or actual trip duration whichever is less subject to the terms & conditions of reliance Corporate Flexi travel care insurance policy. Premium
is to be paid and cover is to be taken prior to starting of the trip.
Any Pre-existing conditions: No
Plan Name: Cyient New Geographical Scope: Worldwide including USA and Canada
Country of Visit: Nil
Coverage Details Sum Insured (in USD) Deductiable (in USD)
Medical Expenses Cover Including Transportation, Evacuation And Repatriation Of Mortal 250000 50
Remains
Dental Care Expenses 1000 50
Loss Passport 300 25
Total loss of checked in baggage. 1000
Delay of Checked Baggage 125 12 Hours
Personal Accident 30,000
Accidental death and dismemberment-common carrier 10,000
Personal Liability 200,000
Daily Allowance in Case of Hospitalisation 25 per day ( 6 days max) 2 Days
Financial Emergency Assistance *** 1000
Hijack Distress Allowance. 75 per day (7 days max) 12 Hours
Trip Delay 50 per day (6 days max) 12 Hours
Trip Cancellation & Interruption 1000
Missed Connection 300
Two way Compassionate Visit Return Fare for any one accompanying person
- spouse / child / family doctor
Home burglary Insurance (in Indian Rs) 200,000
Alternate Employee or Resumption of Assignment expenses 2,000
Emergency Accommodation Expenses 1,000
Any One Illness(Applicable to above 60 years of age) 17,500
Any One Accident(Applicable to above 60 years of age) 35,000
Warranties/ Conditions
• 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.
• The insured person has no past history of any illness/hospitalization.
• Per baggage maximum 50% and per item in baggage max 10%
• In case of financial emergency occurring in Asian Countries the maximum sum insured applicable would be USD 300.
• Warranted that any medical expenses incurred during the period of insurance which arise out of any pre-exisitng 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.
• For age below or 60 years the limit of liability of the company should be restricted to US $1,00,000 per illness/disease/accident sustained or contracted within the period of insurance whilst on the trip
abroad that may lead to one or more medical expenses and/or hospitalization expenses.
Special Conditions: :DUUDQWHGWKDW3XUSRVHRIYLVLWZLOOEHIRUHPSOR\PHQWSXUSRVHRQO\
:DUUDQWHGWKDW'HFODUDWLRQRIDQ\3UHH[LVWLQJ&RQGLWLRQXVLQJZRUGVWHUPVZKLFKPHDQDQ\GLVHDVHLOOQHVVZKLFKDUHVDPHRUVLPLODUWR&DQFHU/HXNHPLD0DOLJQDQW7XPRU&DUGLDF
DLOPHQWV&23'+,9$,'6,QVXOLQ'HSHQGHQW'LDEHWHV.LGQH\$LOPHQW/LYHU'LVHDVH1HXURORJLFDO'LVRUGHU6WURNH3DUDO\VLV7KDODVHPLDZLOOUHQGHUWKLVSROLF\QXOODQG9RLGDELQLWLR
DQGWKH&RPSDQ\VKDOOKDYHQROLDELOLW\XQGHUWKHFHUWLILFDWH
3HUDFFLGHQW3HU*URXSOLPLW86'DQG$Q\RQH\HDU86'
5HSDWULDWLRQRI0RUWDOUHPDLQV86'
3HUVRQDOOLDELOLW\SHULQFLGHQFHOLPLWHGWR86'
:DUUDQWHGWKDWSROLF\GRHVQRWFRYHUDQ\FODLPDULVLQJRXWRIVSRUWLQJDFWLYLWLHVRUSDUWLFLSDWLRQ
)RUGHWDLOVRQFRYHUDJHH[FOXVLRQWHUPVDQGFRQGLWLRQVWKHFHUWLILFDWHVKRXOGEHUHDGZLWKPDVWHUSROLF\LVVXHGWR&\LHQW/LPLWHGYLGHSROLF\QR0
Premium Details
Net Premium: Rs.720.00 Service Tax: Krishi Kalyan Cess: Swachh Bharat Cess: High Edu Cess: Rs.0.00 Total Premium: Rs.828
Rs.100.80 Rs.3.60 Rs.3.60
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Consolidated Stamp duty Paid vide GRAS GRN No. MH007955580201617E dated 25th January 2017**** Not Applicable for the State of Jammu & Kashmir

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 Reliance Travel Care Insurance Policy - Online Proposal Form

Please find attached herewith Policy No.181651728320113205 which has been issued based on the details furnished to us by Proposer / Insured Person:-

Details of Insured Person

Name Date of Birth 5HODWLRQVKLS 3DVVSRUW Name of Nominee 5HODWLRQVKLSZLWK 3URIHVVLRQDO

ZLWK3URSRVHU 1XPEHU 1RPLQHH 6SRUWV
SHUVRQ
SIVARAMAN KUMAR 22/02/1993 Self M2741543 CYIENT LTD Employer No

Details of Pre-existing Condition

Pre-existing illness / Injury / Condition if any Suffering Since Under Medication

No No No

Whether Resident of India : Yes

Mailing Address : 4th Floor, A wing, Plot No.11, Soft,Info City, Madhapur,Hyderabad-500081,HYDERABAD - ,Andhra Pradesh,India

Telephone No. : Mobile No.: 9003785953

E-mail id :

Visa Type : NA

Policy Period : From: 13-Mar-2017 To 10-Jun-2017 Geographical Coverage: Worldwide including USA and Canada

Plan : CORPORATE FLEXI - Cyient New - 250000

Please go through the details as furnished above and also as provided in the Policy Schedule and confirm that they are in order. Should you feel that there are any discrepancies /
variations, you are requested to write back to us immediately at services.rgicl@rcap.co.in for necessary changes / rectification. In the absence of any written communication from you within
7 days or commencement of Policy Period whichever is earlier , it is hereby agreed and understood that the above statements, answers and particulars are complete, correct and true in all
respects and are the basis on which this Policy is being granted and that if, after insurance is effected, it is found that the above statements, answers or particulars are incorrect or untrue in
any respect, the policy will be considered Null and Void-ab-initio and the Company shall have no liability under the policy
Declaration:

Policy has been issued basis Insured Person(s)

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Note:In the event of dishonour of cheque, this policy document automatically stands cancelled from inception of whether a separate communication is sent or not.
In witness whereof this policy has been signed at Mumbai on this 10 day of Mar 2017
For and on behalf of Reliance General Insurance Company Limited.

Authorised Signatory
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 Providers.
EUROP ASSISTANCE INDIA PVT. LTD.
C-301, Business Square,Andheri-Kurla Road,Chakala
Andheri(E), Mumbai - 400 093, INDIA
are at your disposal for 24 hours during 365 days/year.
In case of any requirement of any emergency assistance whilst abroad,Please contact the helpline numbers given below :
International Toll Free line :
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,VUDHO6RXWK$IULFD±DQGIRUWKHIROORZLQJFRXQWULHV1HWKHUODQGV%HOJLXP,WDO\1RUZD\3RODQG1HZ=HDODQG3RUWXJDO8QLWHG.LQJGRP0DOD\VLD&KLQD
7DLZDQ6ZHGHQ$XVWULD&]HFK5HSXEOLF'HQPDUN)UDQFH*UHHFH+XQJDU\*HUPDQ\6SDLQ6ZLW]HUODQG
Dedicated National Toll Free Help Line : 1800 209 5522
Land Line Numbers : +91 22 67347843 & +91 22 67347844 Fax Number : +91 22 67347888
Email : reliance@europ-assistance.in Website : www.europ-assistance.com

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