CERTIFICATE OF INSURANCE-EASY TRAVEL GROUP TRAVEL HEALTH

Policy No.: 110103/32001/2017/A007650/ET00175042 Certificate No: ET00175042

Account No: A007650 GSTIN of Issuing Office 06AAGCA1654H1ZW
Broker/Agency Code: 80091363 Issuing Office: Gurgaon

Policyholder's Details:
Policyholder's Name: Make My Trip
Policyholder's Address: Tower A, SP Infocity , Plot No:243, Udyog Vihar-1 , Gurgaon , 122016
Contact Details: OBT.Insurance@makemytrip.com

Traveller Details:
Insured Person's Name: Hariharan Natarajan
Gender: Male Date of Birth: 01-Jan-1990
Nationality: Indian Passport No: P0078587 Issuing Country: INDIA
Insured Address: 243 SP Infocity, Udyog Vihar Phase 1 Gurgaon Sonipat
Contact Nos: 9551202237
Nominee Name: Legal Heir Relationship with Nominee: Legal Heir
The nominee must be an immediate relative of the policy holder. For all other insured persons the policy holder shall be the nominee

Policy Details:
Plan Name: Bronze- Asiapac Geography: Asiapacific Excluding Japan
Policy Period: From 06-Sep-2017 00.00am (Commencement Date) To 06-Sep-2017 23.59pm (Expiry Date) Trip duration: 1 Days

Coverage Details:
S.No Benifits: Deductible: Sum insured:
1. Medical Expenses $100 $50000
2. Repatriation of Mortal Remains Nil $7500
3. Personal Liability Nil $25000
4. Personal Accident Nil $10000
5. Personal Accident- Common Carrier Nil $5000
6. Hijack Daily Allowance 12Hrs $250
7. Total Loss of Checked-in Baggage Nil $500
8. Financial Emergency Cash Nil $300
9. Loss of Passport $30 $200
10. Dental Treatment $100 $250
11. Delay of Checked-in Baggage 12Hrs $200

Special Condition applying to the Policy:

Dental Treatment, Repatriation of Mortal Remains, Hospital Daily Allowance (if reflected above) will be sublimit under Medical Expenses Sum Insured. Medical Evacuation will
be covered under Medical Expenses Sum Insured.
Exclusions/Special Conditions(if any):
Member ID Insured Person’s Name Exclusion/Special Condition (if any)
MT00175042 Hariharan Natarajan

Premium Details:
Net Premium (Rs.) IGST/(SGST/UTGST+CGST)/J&K GST whichever applicable (Rs.) Gross Premium (Rs.)
61.02 10.98 72
Amount paid Rs.72 (Rs.Seventy Two)

J&K TIN: 01871052106

Original for Recipient/ Duplicate for Supplier
Whether tax is payable on reverse charge basis No
Description/ Accounting Code of Service: Travel Insurance Services/ 997136

Assistance Service & claims Notification (TPA) Address for Claims Submission
When Outside India: Claims Department
From USA: Toll Free: +1877 387 8317 (Toll Free 24 x 7) Apollo Munich Health Insurance Company Limited
From Canada: Toll Free: +1877 695 6492 (Toll Free 24 x 7) C/O Europ Assistance India Pvt. Ltd
From Rest of the world: + 91 22 6734 7845 (Call Back Facility) C-301, Business Square
When in India: Andheri- Kurla Road, Chokala
Toll Free: 1 800 209 4440 (Monday to Friday 9 am to 6 pm ) Andheri (E), Mumbai-400093, INDIA
Landline: + 91 22 6734 7846 ( Monday to Friday 9 am to 6 pm )
Fax +91 22 67347888 / E mail: apollomunich@europ-assistance.in

Location: Gurgaon For and on behalf of Apollo Munich Health Insurance Company
Limited

Date 31-Aug-2017 Signature

Apollo Munich Health Insurance Co. Ltd.
2nd & 3rd floor,iLABS Centre, Plot no. 404-405, Udyog Vihar-III, Gurgaon-122016,Haryana.
Corp. office: 1st Floor,SCF-19,Sector-14,Gurgaon-122001,Haryana.Regd. Office: Apollo Hospitals Complex, Jubilee Hills, Hyderabad- 500033,Telangana.
Tel : +91-124-4584333 Fax : +91-124-4584111 www.apollomunichinsurance.com,customerservice@apollomunichinsurance.com
IRDA Registration Number-131 Corporate Identity Number : U66030AP2006PLC051760