Signed

by:Mr.Anand
Singhi
Date:2017.01.09

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 4th Floor,chintamani Avenue,Next to virvani Industrial Estate,offwestern express Highway,Goregaon East,Mumbai055
400063 , MUMBAI, MAHARASHTRA, INDIA,PinCode-400063. Contact No.022-33123123
Certificate Number:1105572832111202

Master Policy Number: 9202562832M00003

Details of the Insured

Name of the Proposer : BALMER LAWRIE CO LTD
Adress :Scope Complex, Ground FloorCore 8, Lodhi Road, ,New Delhi-110003

Tel./Mobile No:
E-mail ID:

Details of the Insured Person

Name : M.GANESAN

Date Of Birth:11/07/1967

Nominee Name:G.VIJAYALAKSHMI

Relationship with Nominee:Spouse

Gender : M

Passport No:H0350548

Address of Insured Person: [CLIENT:OP000151-SAMPADA] ,125 /J 2 BHARATHINAGAR,RAJAPALAYAM - 626117,Tamil Nadu,India

Landline Number:

Mobile No: 7710091444

E-mail ID: GANESANONGC@YAHOO.COM

This Policy is valid From 00:00 hour on : 27-Jan-2017 To 02-Mar-2017 midnight

Number of Travel Days:35
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: Balmer 300k

Geographical Scope: Worldwide Excluding 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

Remains
Dental Care Expenses

300000

Nil

500

50

Loss Passport

300

25

Total loss of checked in baggage.

1,200

Nil

Delay of Checked Baggage

100

12 Hours

Personal Accident

25,000

Nil

Accidental death and dismemberment-common carrier

5,000

Nil

Personal Liability

2,00,000

Nil

Daily Allowance in Case of Hospitalisation

25 per day ( 6 days max)

2 Days

Financial Emergency Assistance ***

300

Nil

Hijack Distress Allowance.

75 per day (7 days max)

12 Hours

Trip Delay

50 per day ( 6 days max)

12 Hours

Trip Cancellation & Interruption

600

Nil

Missed Connection

300

Nil

Two way Compassionate Visit

Nil

Home burglary Insurance (in Indian Rs)

Return Fare for any one accompanying

person - spouse / child / family doctor
2,00,000

Golf Coverage

500

Nil

Pet Care

300

Nil

Seat Bumping

300

Nil

Any One Illness(Applicable to above 60 years of age)

15,000

Nil

Loss of International driving license

300

Nil

Any One Accident(Applicable to above 60 years of age)

30,000

Nil

Nil

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.
In case of financial emergency occurring in Asian Countries the maximum sum insured applicable would be USD 300.
Special Conditions: :DUUDQWHGWKDW3XUSRVHRIYLVLWZLOOEHIRUOHLVXUHRUSHUVRQDOEXVLQHVVSXUSRVHRQO\
:DUUDQWHGWKDWSD\PHQWIRU/LIH6DYLQJXQIRUHVHHQHPHUJHQF\PHDVXUHVSURYLGHGWRWKH,QVXUHG,QVXUHG3HUVRQE\WKH3K\VLFLDQIRUKRVSLWDOLVDWLRQDULVLQJRXWRIDGHFODUHG DFFHSWHG
SUHH[LVWLQJGLVHDVHVKDOOEHUHVWULFWHGWRRIVXPLQVXUHGRUPD[86ZKLFKHYHULVORZHUSHULQVXUHGLQDJJUHJDWHGXULQJWKHFHUWLILFDWH3HULRGVXEMHFWWR6XP,QVXUHGXQGHUWKH
0HGLFDO([SHQVHV$OVRWKDW'HFODUDWLRQRIDQ\3UHH[LVWLQJ&RQGLWLRQXVLQJZRUGVWHUPVZKLFKPHDQDQ\GLVHDVHLOOQHVVZKLFKDUHVDPHRUVLPLODUWR&DQFHU/HXNHPLD0DOLJQDQW
7XPRU&DUGLDFDLOPHQWV&23'+,9$,'6,QVXOLQ'HSHQGHQW'LDEHWHV.LGQH\$LOPHQW/LYHU'LVHDVH1HXURORJLFDO'LVRUGHU6WURNH3DUDO\VLV7KDODVHPLDZLOOUHQGHUWKLVFHUWLILFDWHQXOO
DQG9RLGDELQLWLRDQGWKH&RPSDQ\VKDOOKDYHQROLDELOLW\XQGHUWKHFHUWLILFDWH
5HSDWULDWLRQRI0RUWDOUHPDLQV86'
$Q\H[SHQVHVUHODWHGWRSUHH[LVWLQJLOOQHVVGLVDELOLW\GLVHDVHVDQGLWVUHODWHGFRPSOLFDWLRQVFRQVHTXHQFHVDUHQRWSD\DEOHXQGHUWKHSROLF\
$FFLGHQWDO'HDWKFRYHUDJHIURPRULJLQDOUHVLGHQFHLQLQGLDWLOODLUSRUWDQGIURPDLUSRUWWLOORULJLQDOUHVLGHQFHLQLQGLDLVVXEOLPLWHGWR,15XQGHU3HUVRQDO$FFLGHQW7RWDOOLDELOLW\RI
WKHFRPSDQ\ZLOOQRWH[FHHGWKH6XPLQVXUHGPHQWLRQLQWKHFRYHUDJH
$Q\FODLPDULVLQJRXWRIVSRUWLQJDFWLYLWLHVLQVRIDUDVWKH\LQYROYHWKHWUDLQLQJRUSDUWLFLSDWLRQLQFRPSHWLWLRQVRISURIHVVLRQDORUVHPLSURIHVVLRQDOVSRUWVSHUVRQVLVH[FOXGHG
%RXQFHGKRWHOERRNLQJLVVXEOLPLWHGWR86'XQGHUWKH6HDW%XPSLQJ7RWDOOLDELOLW\RIWKHFRPSDQ\ZLOOQRWH[FHHGWKH6XPLQVXUHGPHQWLRQLQWKHFRYHUDJH
$ERYH PDUNFRQGLWLRQLVQRWOLDEOHIRUDJHJURXS\HDUVWR\HDUV
)RUDJHDERYH\HDUV7KH&RPSDQ\VKDOOQRWSD\IRUDQ\WUHDWPHQWRI2UWKRSHGLFGHJHQHUDWLYHRURQFRORJLFDOGLVHDVHV
)RUGHWDLOVRQFRYHUDJHH[FOXVLRQWHUPVDQGFRQGLWLRQVWKHFHUWLILFDWHVKRXOGEHUHDGZLWKPDVWHUSROLF\LVVXHGWR%DOPHU/DZULH$QG&R/WGYLGHSROLF\QR0

Premium Details
Net Premium: Rs.2,316.00

Service Tax:
Rs.324.24

Krishi Kalyan Cess:

Rs.11.58

Swachh Bharat Cess: High Edu Cess: Rs.0.00

Rs.11.58

Total Premium: Rs.2,663

6HUYLFH7D[5HJLVWUDWLRQ1R$$%&5%67
&DWHJRU\*HQHUDO,QVXUDQFH%XVLQHVV6HUYLFH

Consolidated Stamp duty Paid vide GRAS GRN No. MH004071849201617E dated 07 September 2016**** Not Applicable for the State of Jammu & Kashmir

IRDAI Registration No. 103

&RUSRUDWH,GHQWLW\1XPEHU80+3/&
5HOLDQFH*HQHUDO,QVXUDQFH&RPSDQ\/LPLWHG
5HJLVWHUHG2IILFH+%ORFNVW)ORRU'KLUXEKDL$PEDQL.QRZOHGJH&LW\1DYL0XPEDL
&RUSRUDWH2IILFH5HFWLILHU+RXVH1DLJDXP&URVV5RDG1H[WWR5R\DO,QGXVWULDO(VWDWH:DGDOD:0XPEDL
7UDGH/RJRGLVSOD\HGDERYHEHORQJVWR$QLO'KLUXEKDL$PEDQL9HQWXUHV3ULYDWH/LPLWHGDQGXVHGE\5HOLDQFH*HQHUDO,QVXUDQFH&RPSDQ\/LPLWHGXQGHU/LFHQVH

$Q,62&HUWLILHG&RPSDQ\
3$11R$$%&5%

Page 1 of 2

Reliance Travel Care Insurance Policy - Online Proposal Form

Please find attached herewith Policy No.1105572832111202 which has been issued based on the details furnished to us by Proposer / Insured Person:Details of Insured Person
Name

5HODWLRQVKLS
ZLWK3URSRVHU

Date of Birth

M.GANESAN

11/07/1967

Self

3DVVSRUW
1XPEHU
H0350548

Name of Nominee

G.VIJAYALAKSHMI

5HODWLRQVKLSZLWK
1RPLQHH
Spouse

3URIHVVLRQDO
6SRUWV
SHUVRQ
No

Details of Pre-existing Condition

Pre-existing illness / Injury / Condition if any
No

Suffering Since

Under Medication

No

No

Whether Resident of India

: Yes

Mailing Address

: [CLIENT:OP000151-SAMPADA] ,125 /J 2 BHARATHINAGAR,RAJAPALAYAM - 626117,Tamil Nadu,India

Telephone No.

E-mail id

: GANESANONGC@YAHOO.COM

Visa Type

: NA

Policy Period

: From: 27-Jan-2017 To 02-Mar-2017

Plan

: CORPORATE FLEXI - Balmer 300k - 300000

Mobile No.:

7710091444

Geographical Coverage:

Worldwide Excluding USA and Canada

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)
,VDUHQRWWUDYHOOLQJDJDLQVWDGYLFHRI0HGLFDO3UDFWLWLRQHU
,VDUHQRWRQ:DLWLQJOLVWIRUDQ\0HGLFDOWUHDWPHQW
,VDUHQRWWUDYHOOLQJIRUWKHSXUSRVHRIREWDLQLQJ0HGLFDOWUHDWPHQW
+DYHQRWUHFHLYHGDWHUPLQDOSURJQRVLVIRUDPHGLFDOFRQGLWLRQEHIRUH-RXUQH\
%HLQJLQ,QGLDEHIRUHWDNLQJFRYHUDQGFRPPHQFHPHQWRI7ULS
EHLQJ5HVLGHQW,QGLDQ
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 09 day of Jan 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 :
6LQJDSRUH7KDLODQG+RQJNRQJLV86$&DQDGD
$XVWUDOLD-DSDQ
,VUDHO6RXWK$IULFDDQGIRUWKHIROORZLQJFRXQWULHV1HWKHUODQGV%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

IRDAI Registration No. 103

&RUSRUDWH,GHQWLW\1XPEHU80+3/&
5HOLDQFH*HQHUDO,QVXUDQFH&RPSDQ\/LPLWHG
5HJLVWHUHG2IILFH+%ORFNVW)ORRU'KLUXEKDL$PEDQL.QRZOHGJH&LW\1DYL0XPEDL
&RUSRUDWH2IILFH5HFWLILHU+RXVH1DLJDXP&URVV5RDG1H[WWR5R\DO,QGXVWULDO(VWDWH:DGDOD:0XPEDL
7UDGH/RJRGLVSOD\HGDERYHEHORQJVWR$QLO'KLUXEKDL$PEDQL9HQWXUHV3ULYDWH/LPLWHGDQGXVHGE\5HOLDQFH*HQHUDO,QVXUDQFH&RPSDQ\/LPLWHGXQGHU/LFHQVH

$Q,62&HUWLILHG&RPSDQ\
3$11R$$%&5%

Page 2 of 2