BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory and Development Authority of India [IRDAI] vide Regd. No.113)
Regd. Office: Bajaj Allianz House, Airport Road, Yerwada, Pune 411006 (India)

Quotation for Travel – Travel Prime Individual Silver

Issuing Office Bajaj Finserv Building,1st Floor Pune Maharashtra,411014

Proposer Name Srinivasulu Gadham Shetti Quotation Number 11-9910-0001001523-00

IMD Code: 10041726 IMD Name : D2C INSURANCE BROKING PVT LTD Sub IMD Code : Sub IMD Name:

PROPOSER DETAILS QUOTATION DETAILS

Customer ID PI20560863 Quotation Issued on 06/10/2021

Email Address SRINU6066@GMAIL.COM Contact Details 9177937536

Travel Category Travel Plan DOB Destination Policy Start Date Policy End Date No Of Days
Individual Travel Prime Individual Silver 08/06/1990 POLAND 01/11/2021 29/04/2022 180

Basic Benefits Max Limit Deductible Basic Benefits Max Limit Deductible
Golfer’s Hole-in-one USD 250 Nil PA Cover in India INR 50000 Nil

Trip Delay USD 25 per 12 Hrs 12 Hrs. Bounced Hotel USD 500 Nil
delay period up to
USD 120 Hijack Cover USD 50 per 24 Hrs Nil
Emergency Cash Benefit USD 500 Nil delay period up to USD
300
Home Burglary Insurance INR 100000 Nil Missed Connection USD 100 12 Hrs.

Personal Accident USD 15000 Nil Difference in Airfare due to delayed or early USD 500 Nil
return
Personal Liability USD 100000 USD 100 Delay of Checked Baggage USD 100 12 Hrs.
Hospitalization Daily Allowance USD 20 per 24 Hrs Nil Loss of Checked Baggage USD 500 Nil
delay period up to
USD 120 Loss of Passport USD 250 USD 25
Trip Cancellation USD 500 Nil
Accidental Death and Disability (Common USD 2500 Nil
Medical Expense and Evacuation USD 50000 USD 100 Carrier)
Repatriation USD 5000 Nil
Emergency Dental Pain Relief USD 500 USD 100

Trip Curtailment USD 200 Nil

Add-on Cover/ Rider Limits (Max for entire policy period) Deductible Premium

Premium (all the figures are in INR):

Base Premium (A) 4288

Final Premium – FIVE THOUSAND SIXTY RUPEES ONLY Rider Premium (B) 0
Net Premiun (A + B) 4288
Central GST 0
State GST 0
UGST 0
IGST 772
CESS
Final premium 5060

Remarks This quote is subject to revision in case of change in any material information provided to us.

Quote validity 30 Days

Important Notes:
This quotation is prepared based on information provided to us and is subject to condition that there is no change in provided information.
1 This quotation is only for the purpose of indicating the premium. The liability of the company commences only after receipt of payment of premium as demanded.
2 Payment of quoted premium as shown above is the confirmation of acceptance of all terms & conditions of this quote.
3 The terms are subject to no changes in Government Taxes /Duties /Similar charges till policy inception

PROHIBITION OF REBATES. The Insurance Act, 1938.11

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 BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED
(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory and Development Authority of India [IRDAI] vide Regd. No.113)
Regd. Office: Bajaj Allianz House, Airport Road, Yerwada, Pune 411006 (India)
Corporate Identification Number: U66010PN2000PLC015329 Printed on : 06-oct-2021 11:15:26 |WEB

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