4168 O-Tmcas 298685235 00 000

VOYAGER GROUP TRAVEL INSURANCE
PART I OF THE POLICY SCHEDULE
(UIN : ICITGBP22095V032122)
Date: 19/Jul/2023
To,
SYSESB00172313737
JITENDRA SURESH KATARIA
Shree Siddhivinayak Temple, ICICI Lombard House 414 P.Balu Marg, Swatantryaveer Savarkar Rd, Prabhadevi, Mumbai,
INDIA, Maharashtra - 400025
Mobile Number: 9969305814
Email ID: jitendra.katariainsurance@gmail.com,Prachi.Chavan@thomascook.in,Mujeeb.Sarang@thomascook.in
Dear Mr. / Ms. JITENDRA SURESH KATARIA
Sub: Issuance of Policy Certificate no. 4168/O-TMCAS/298685235/00/000 under your application for Group Travel Insurance
Policy dated 20/Jul/2023.
We would like to thank you for investing your faith in us. Please find enclosed herewith your Policy Certificate, Policy wordings
& Customer Information Sheet based on which your insurance Policy has been issued.
Insured Person Details:
Name of Proposer JITENDRA SURESH KATARIA

Domestic/Overseas Overseas
Geographical Scope of Policy Worldwide (Including Schengen Countries)
No. of Travel Days 9
Countries being visited SPAIN
Period of Insurance Overseas- 20/Jul/2023 hours 12:00 AM
To 28/Jul/2023 hours 11:59 PM
Name of Insured JITENDRA SURESH Date of Birth of Insured 10/May/1985
KATARIA
PAN No. of Insured Passport No. of Insured V4755378
Relationship of Insured Self Address of the Insured Shree Siddhivinayak Temple,
with Proposer ICICI Lombard House 414 P.Balu
Marg, Swatantryaveer Savarkar
Rd, Prabhadevi, Mumbai, INDIA,
Maharashtra - 400025
Resident Status Country of issue of Passport
Politically Exposed Person (PEP)/close relative of PEP: No
Medical expenses due to Covid-19 is covered if contracted during the travel period as per policy terms and
conditions.
1
Please go through the details as furnished in the format and also as provided in the Policy document 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
customersupport@icicilombard.com or call at 1800 2666 for necessary changes/rectification. In the absence of any
communication from you within 15 days of receipt of Policy, we would take it that you have accepted the contents and the
coverage to be confirming to your proposal.
102/20141021/66
ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICITGBP22095V032122
Mailing Address: Registered Office Address: Toll free no : 1800 2666
601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Alternate no : 86552 22666 (chargeable)
New Linking Road, Malad (West) Marg, Near Siddhi Vinayak Temple, E-mail : Customersupport@icicilombard.com
Mumbai - 400 064 Prabhadevi, Mumbai 400 025 Website : www.icicilombard.com
ICICI Lombard General Insurance Company Limited (IRDAI Regn. No. : 115) CIN No. L67200MH2000PLC129408
Master Policy Number - 4168/O-TMCAS/292988663/00/000 UIN: ICITGBP22095V032122
Voyager Group Travel Insurance

Policy Certificate
On receipt of full premium from the Policyholder as named in this Schedule, Group Travel Insurance
4168/O-TMCAS/292988663/00/000 dated 29/05/2023 has been issued at Mumbai, by ICICI Lombard General Insurance Company
Limited to the Policyholder, THOMAS COOK INDIA LIMITED as specified in the Policy, and is governed by, and is subject to,
the terms, conditions & exclusions therein contained or otherwise expressed in the said Policy.
The certificate issued to the customers/employees/members of THOMAS COOK INDIA LIMITED under the signature of an
authorized signatory of ICICI Lombard General Insurance Company Limited, represents the availability of the Benefits under the
Policy to the Insured Person named below, subject to the terms, conditions and exclusions expressed in the said Policy, but not
exceeding the Sum Insured as specified below.
(PART I OF THE POLICY SCHEDULE)
POLICY CERTIFICATE NUMBER : 4168/O-TMCAS/298685235/00/000

Alternate Policy No : 0
Master Policy Number : 4168/O-TMCAS/292988663/00/000
Issued At : Mumbai Stamp Duty : 1
GSTIN Number : Invoice No : 1007231343704

Domestic/Overseas : Overseas
Geographical Scope : Worldwide (Including Schengen Countries)
Trip Details
Type of Trip For Overseas- Single Trip
Details of Trip* 1 From 20/Jul/2023 To 28/Jul/2023 No. of Days 9
Place of Origin INDIA Destination SPAIN
Common Carrier/Public
Carrier Opted
Adventure sports Activities to
be undertaken while on trip
Detailed Itinerary of the Trip* Overseas -
Proposer/Policyholder Details
Name of the Proposer JITENDRA SURESH KATARIA
Insured Details
Name of the Insured JITENDRA SURESH KATARIA
Gender of the Insured Male
Age as on Policy Start Date 38.0
Mailing address/ Residential Address of the Insured Shree Siddhivinayak Temple, ICICI Lombard House 414
P.Balu Marg, Swatantryaveer Savarkar Rd, Prabhadevi,
Mumbai, INDIA, Maharashtra - 400025
Occupation Service
Mobile Number 9969305814
Email ID jitendra.katariainsurance@gmail.com,Prachi.Chavan@thomasc
ook.in,Mujeeb.Sarang@thomascook.in
Passport Number V4755378
Country of Issue of Passport
Resident Status
PAN Number/ National ID No.
Pre-Existing Disease (if any):
Debit/Credit Card Number (if any):
Name of Nominee LEGAL HEIR
Relationship of Nominee with Insured LEGAL HEIR
102/20141021/66

Policy Details
Period of Insurance Overseas- From 20/Jul/2023 to 28/Jul/2023
Journey Start Date, if different from Policy Start Date
No. of Travel Days Overseas- 9
Name of Nominee LEGAL HEIR
If Nominee is minor, name of guardian
Relationship of Nominee with Insured Person LEGAL HEIR
Name of Assignee
COVERAGE TABLE - FOR OVERSEAS POLICY
Overseas
(Coverage Table to be customized in accordance to the Covers & Extensions opted)
Cover-specific
Section and Indemnity/ Deductible, if Franchise, if
Sum Insured Co-Pay, if any Condition, if
Coverage Benefit any any
any
Medical Expenses for Illness & Accidental Injury
Hospitalization USD 50,000 Indemnity USD 250 NA NA NA
Expenses for
Illness & Injury
Daily Allowance limit of USD 25 Benefit 24 Hours NA NA limit of USD 25
in case of per per day upto
Hospitalization max 5 Days
Non Medical Covers
Compassionate USD 1000 Indemnity NIL NA NA NA
Visit
Loss of USD 500 Benefit USD 50 NA NA NA
Checked-In
Baggage
Electronic USD 500 Indemnity NIL NIL NIL NIL
Equipment Loss
Damage to USD 50 Benefit NIL NIL NIL NIL
baggage during
transit
Delay of USD 100 Benefit 6 hrs NA NA NA
Checked-In
Baggage
Loss of Baggage USD 1,000 Indemnity USD 100 NA NA NA
and Personal
effects
Trip Cancellation USD 1,000 Indemnity USD 50 NA NA NA
Trip Interruption USD 1,000 Indemnity USD 50 NA NA NA
or Curtailment
Hotel extension USD 500 Indemnity NIL NIL NIL NIL
due to
contingency
Personal Liability USD 1,00,000 Indemnity NIL NIL NIL NIL
Hijack Distress USD 50 per day Benefit 12 Hours NA NA USD 50 per day
Allowance for m for max USD
300
Personal USD 10,000 Benefit NIL NIL NIL NIL
Accident
Financial USD 1,000 Benefit NIL NIL NIL NIL
Emergency
Cash Allowance
(lump sum)
Common 50 Benefit 4 hours NA NA NA
Carrier/Public
Carrier delay
102/20141021/66

Cover-specific
Section and Indemnity/ Deductible, if Franchise, if
Sum Insured Co-Pay, if any Condition, if
Coverage Benefit any any
any
Non Medical Covers
Missed 100 Indemnity NIL NIL NIL NIL
Connection (All
Common
Carrier/Public
Carrier)
Burglary (Home INR 1,00,000 Indemnity NIL NIL NIL NIL
contents)
Loss of USD 200 Benefit USD 30 NA NA NA
Passport /
International
Driving License
Other Medical Covers
Medical USD 75000 Indemnity USD 100 NA NA NA
Evacuation
Dental USD 250 Indemnity USD 50 NA NA NA
Treatment
PREMIUM DETAILS
Net Premium (in `) ` 831.33
CGST: (9 %) ` 74.82
SGST: (9 %) ` 74.82
Total Premium (in `) ` 981
GSTIN of ICICI Lombard GIC 27AAACI7904G1ZN
HSN/SAC Code 997136/ GENERAL INSURANCE SERVICES
Servicing Branch: Mumbai
Servicing Branch Address: 414, ICICI LOMBARD HOUSE, VEER SAVARKAR MARG, NEAR
SIDDHI VINAYAK TEMPLE MAIN GATE, PRABHADEVI,
MUMBAI, 400025, MAHARASHTRA
We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards i s more than the aggregate turnover notified under
sub-rule (4) of rule 48, we are not required to prepare an invoice in terms of the provisions of the said sub-rule.
The stamp duty of `1 paid vide deface no.CSD6142023662 dated 20/Feb/2023.

thomas cook india
As per the Circular on Travel insurance Products and operational matters (Ref- IRDAI/HLT/CIR/MISC/174/09/2019)
dated 27th September 2019,
• Premium for Group domestic policies should not be received more than 90 days in advance to the date of commencement of
the risk covered or along with purchasing travel ticket, whichever is earlier.
• While offering insurance policies under group mode through an online platform, customers should be specifically provided
with an option to select travel insurance. Further the details of the insurer, premium with the tax breakup and the policy terms
and conditions should be readily available on the online platform. The customer should be clearly conveyed that his/her
participation in the policy is entirely voluntary.
• Where a customer proposes to enroll under the group policy, his/her express consent confirming that he/she has read and
understood all the terms and conditions shall be obtained on the said platforms
• In case the customer who opts for insurance wishes to continue without enrolling under the policy, he/she should also be
provided an option for Opting out or de-selecting the option before concluding the transaction
• In the absence of adherence to the compliance with the above mentioned norms, the master policy will be liable to be
cancelled and will be considered null and void.
• The circular is in force from 1st October 2019 with immediate effect.
IMPORTANT NOTES:
1. Insurance cover will start only on receipt of full premium stated in PART I of the Policy Schedule by ICICI Lombard General
Insurance Company Limited.
2. Insurance cover is subject to the terms and conditions mentioned in the Policy wordings provided to you with this Certificate.
3. The above covers would not be applicable for persons occupied in underground mines, explosives and electrical installations
on high tension lines unless otherwise covered and stated in the Policy Schedule.
102/20141021/66

4. Major exclusions: Intentional self-injury, suicide or attempted suicide whilst under the influence of intoxicating liquor or
drugs, any loss arising from an act of breach of law with or without criminal intent. Please refer to the Policy wordings for a
complete list of exclusions.
5. For any endorsements such as name correction or change in nominee details, you can contact us at Toll Free Number
1800-2666 or Email us at customersupport@icicilombard.com or visit our nearest branch.
6. For Overseas claims, Contact ICICI Lombard 24hr Help Line number for assistance and registering your claim:
In USA & Canada (Toll Free) +1 844 871 1200; Rest of the World (Call Back Facility) +91 124 449 8778
National Toll Free Number 1800 102 5721; Fax Number +91 124 4006674
Email Address icicilombard@falck.com
OR Login to the e-claim link as provided by the Company details of which will be mentioned in the policy document or
updated on the Website
For Domestic claims, Address for claim notification: IL Health Care, ICICI LOMBARD HEALTHCARE ICICI BANK TOWER,
PLOT NO.12, FINANCIAL DISTRICT, NANAKRAM GUDA, GACHIBOWLI, HYDERABAD, ANDHRA PRADESH PIN CODE:
500032 or call at 1800 2666
For ICICI Lombard General Insurance Company Limited.
Issuing Office: Mumbai Date : 19/Jul/2023

IRDA Reg No : 115 Misc Code : 168
102/20141021/66

CUSTOMER INFORMATION SHEET - VOYAGER GROUP TRAVEL INSURANCE
Description is illustrative and not exhaustive
Only those covers that have been opted by You / Group administrator are mentioned in the below document
Cover Name Covers In Brief Some Of Major Exclusions Are -

Medical Hospitalization Expenses for Illness & Injury- * Any treatment that is not a part of the treatment for
Expenses for Reimbursement of expenses incurred in case of injury or illness sustained during the policy period
*
Illness & hospitalization due to illness contracted or any Routine physical tests/vaccination/inoculations of any
Accidental Injury due to an Accident during the policy period kind

Injury Daily Allowance in case of Hospitalization- Per day * Any treatment that is not a part of the treatment for
payout on hospitalization due to Illness contracted injury or illness sustained during the policy period
*
or any accidental Injury during the policy period Routine physical tests/vaccination/inoculations of any
kind

Non Medical Loss of Checked-In Baggage- Pro-rated payout for * Losses dues to delay, detention, confiscation by
Covers pieces of baggage permanently lost whilst under custom officials or other public authorities
the custody of common carrier vis-a-vis pieces of
baggage that were checked-in
Electronic Equipment Loss- Compensation of cost * Losses dues to delay, detention, confiscation by
(after depreciation) of the electronic equipment lost custom officials or other public authorities
which formed a part of the checked-in baggage
Damage to baggage during transit- Fixed payout in * Any damage not occurring in the custody of the
case of damage to insured''s checked-in common carrier
* Normal wear and tear of
baggage(s) while it is entrusted to the Common luggage

carrier/Public Carrier
Delay of Checked-In Baggage- Fixed payout in * Delay resulting from detention/confiscation by the
case the checked-in baggage is delayed beyond common carrier or any authorized agency
the period specified in policy certificate
Loss of Baggage and Personal effects- * Any loss of partial Contents of the baggage/hand
Reimbursement for loss of insured''s baggage and baggage or cabin baggage except for loss of sports
personal effects due to theft, burglary, larceny, equipment and/or loss of electronic equipment and/or
robbery, hold-up or any such similar events during loss of valuables
the policy period
Personal Accident- Lump sum payout in case of * Death or Disability arising from or resulting directly or
death or permanent total disablement or permanent indirectly from any illness
* Amounts related to
partial disablement of the insured during the policy medical expenses

period
Personal Liability- Reimbursement of expenses * Liability arising directly/indirectly from, in respect of,
towards payment of legal liability to a third party or due to your wilful, malicious, unlawful and criminal
during the covered trip arising out of accidental acts
death, bodily injury or property damages to third
party
Hijack Distress Allowance- Per day payout payable * If you are in any way involved principally or as an
in the event of an Hijack of the Common accessory in causing or planning the hijack
Carrier/Public Carrier in which the insured is
travelling as a fare paying passenger
Financial Emergency Cash Allowance (lump sum)- * Any loss of money not in personal custody of the
Lump sum payout in case insured is left with no insured
travel funds following an incident of theft, robbery,
larceny etc. during the policy period
Trip Cancellation- Compensation for financial loss * Any change of plans or dis-inclination on the part of
(travel and accommodation) incurred on the insured resulting in cancellation of the trip
* In
cancellation of trip due to unexpected events e.g. case of "Event cancellation" extension, the event should
sickness, natural calamities, terrorist attack etc. not include personal family, political, anti-national or any
other event of illegal nature

Trip Interruption or Curtailment- Compensation for * Any change of plans or disinclination on your part
the financial loss incurred in case insured''s trip is which are not results of any unforeseen circumstances
interrupted and/or insured need to curtail his/her trip outside your control
* Interruption of the Trip either
due to unexpected events beyond his/her control wholly or in part done at the instance of the authority
governing the Common Carrier or the government

102/20141021/66

Cover Name Covers In Brief Some Of Major Exclusions Are -
Common Carrier/Public Carrier delay- Fixed payout * For any departure which is delayed as a result of the
in case of a delay in departure of the scheduled insured or any other person accompanying the Insured
Common Carrier/Public Carrier on the Trip
Missed Connection (All Common Carrier/Public * For any departure which is delayed as a result of the
Carrier)- Reimbursement for official cancellation insured or any other person accompanying the Insured
charges and additional cost incurred to proceed with on the Trip
insured''s planned trip in case he/she fails to
access a connecting flight or connecting Common
Carrier/Public Carrier due to a delayed arrival of
the previous Common Carrier/Public Carrier
Burglary (Home contents)- Compensation for * Loss or damage directly or indirectly, proximately or
financial loss or damage due to burglary/attempted remotely occasioned by or which arises out of or in
burglary at insured''s residence while insured is on connection with riot and strike, civil commotion, terrorist
a covered trip activities.
Compassionate Visit- Reimbursement of Cost of * Any reason mentioned as exclusion under covers-
visit (travel and accommodation) of a family `Hospitalization Expenses for Injury" and/or
member/friend to the insureds place of `Hospitalization Expenses for Illness and injury".
hospitalization for a specified duration if deemed
necessary by the treating medical practitioner
Hotel extension due to contingency- * Any other reason for extension other than the specific
Reimbursement of expenses towards lodging and contingencies mentioned against this cover
boarding for an extended stay at a pre-booked
hotel/accommodation facility if the insureds
departure is delayed due to unexpected events
beyond control
Loss of Passport / International Driving License- A * Loss of the passport or international driving license
fixed benefit amount shall be given to the Insured due to delay or confiscation or detention by the
if he/she loses or damages their original Passport customs, police or public authorities.
or International Driving License
Other Medical Medical Evacuation- Reimbursement of expenses * Any treatment or expense mentioned as an exclusion
Covers for emergency transportation and evacuation under "hospitalization expenses for injury" and/or
services necessitated due to any Illness "hospitalization expenses for illness and injury"
contracted or accidental Injury sustained during the
policy period.
Dental Treatment- Reimbursement of expenses * Any cost incurred for routine dental treatment and
incurred for emergency dental treatment towards consultation
relief from sudden acute pain and/or due to an
accident during the policy period
102/20141021/66

Worldwide (Including Schengen C
Name : JITENDRA SURESH KATARIA

Policy No. : 4168/O-TMCAS/298685235/00/000
Date of Birth : 10/May/1985
Valid From : 20/Jul/2023
Valid To : 28/Jul/2023
Signature Not Verified

Digitally signed by DS ICICI
LOMBARD GENERAL
INSURANCE CO LTD 1
Date: 2023.07.19 12:39:27 IST
102/20141021/66


4168 O-Tmcas 298685235 00 000

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VOYAGER GROUP TRAVEL INSURANCE

PART I OF THE POLICY SCHEDULE

Dear Mr. / Ms. JITENDRA SURESH KATARIA

Insured Person Details:

Name of Proposer JITENDRA SURESH KATARIA

ICICI Lombard General Insurance Company Limited

Master Policy Number - 4168/O-TMCAS/292988663/00/000 UIN: ICITGBP22095V032122

Voyager Group Travel Insurance

(PART I OF THE POLICY SCHEDULE)

POLICY CERTIFICATE NUMBER : 4168/O-TMCAS/298685235/00/000

GSTIN Number : Invoice No : 1007231343704

ICICI Lombard General Insurance Company Limited

ICICI Lombard General Insurance Company Limited

The stamp duty of `1 paid vide deface no.CSD6142023662 dated 20/Feb/2023.

ICICI Lombard General Insurance Company Limited

Issuing Office: Mumbai Date : 19/Jul/2023

ICICI Lombard General Insurance Company Limited

Cover Name Covers In Brief Some Of Major Exclusions Are -

ICICI Lombard General Insurance Company Limited

ICICI Lombard General Insurance Company Limited

Name : JITENDRA SURESH KATARIA

Signature Not Verified

ICICI Lombard General Insurance Company Limited

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