Domestic TravInsure - Specially designed for SpiceJet Passengers

Schedule of Travel Insurance

Issued at Mumbai

Schedule Number:
Policy Validity Dates:

8C647189
From 13/04/2008 to 13/04/2008

(Max covered period 30 days from the first departure date of the insured schedule
flight unless insured returns to the station of origin earlier.)

Applicant/Insured Name: VIKRAM VARMA

Applicant/Insured Address: A S/4 Paraiso De Goa Alto Porvorim
Goa 403521
Benefits subject to terms and conditions for the policy
Benefits
Maximum Coverage
Accidental Death and Dismemberment (24 Hrs)

Deductible

Rs 750,000

Emergency Accidental Medical Reimbursement Rs 100,000

Emergency Medical Evacuation and
Repatriation of Remains

*INCLUDED

24-hr Emergency Assistance Service

*INCLUDED

Trip Cancellation

Up to the Original Cost of Flight

Baggage Loss-Checked

Rs 7,500

Flight Delay

Rs 1,500 per 6 Hrs delay period

up to RS 10,500

Common Carrier Delay

Rs 1,500 per 6 Hrs delay period

up to Rs 10,500

Trip Interruption

Up to the Original Cost of Flight

10% / 50% (Per Article /

Per Bag Limit)

* Included under overall limit of Accident & Sickness

PREMIUM
Tax (12.36%)
Total Premium

INR
INR
INR

115
14
129

Assistance Contact
0091-11-41898858(International SOS)
Email:travinsure.tata-aig@internationalsos.com

Address for submission of claim documents

Claims Department
TATA AIG General Insurance Company Ltd
Ahura Centre, 4th Floor, 82, Mahakali Cave Road,
Andheri (East), Mumbai, India-400093

Important: Any Pre-Existing Medical condition will

be excluded from the policy
The stamp duty of RS.1/- paid by demand draft,
vide Receipt/Challan no. 148356 dated 22nd August 2006

Signed for & on Behalf of TATA AIG General Insurance

Company Ltd.

Date Issued:

10/04/2008

Authorized Signatory

Declaration: The full terms & conditions of your TATA AIG Policy can be viewed or downloaded online at www.spicejet.com.
It is important to read the terms & condition of the Insurance policy & Carry a copy of this certificate for ready reference.
Ahura Centre, 4th Floor, 82, Mahakali Caves Road, Andheri (East), Mumbai 400093, Maharastra, India. TEL +91-22-66930000 FAX +91-22-28305888.
Registered Office: Peninsula Corporate Park, Nicholas Piramal Tower, 9th Floor, Ganpatrao Kadam Marg, Lower Parel, Mumbai 400013, Maharastra, India.
TEL +91-22-66699696 FAX +91-22-56546464.