Bajaj Allianz General Insurance Company Ltd.

Regd. Office GE Plaza, Airport Road, Yerwada, Pune ­ 411006 (India)

TRAVEL POLICY IDENTIFICATION AND SCHEDULE

Policy No.: BACWTTES00233642 IMD Code: 10031022

Insurance Plan: Travel Elite Silver Geographical WORLDWIDE EXCLUDING USA AND
Coverage: CANADA
Insured
Mr P a r a n t h a m a n T h i r u m a l p a d i S r i n i v a s a n B a s k a r a n Passenger: Adult
Person(s):
Date of Birth: 11­Oct­1994 Nominee Name: Manjuu

Passport No: X7420701 State code: 29

51 , Rajeswari nagar , karambakkam , porur, Chennai, Tamil Nadu GSTIN/UIN:
Address:
­ 600116 Contact No.: +91 0701072055

BENEFITS LIMITS(max for entire policy DEDUCTIBLE

period)

Medical Expenses, Evacuation And Repatriation USD 50000 USD 100

Emergency Dental Pain Relief Included in Medical Expenses USD 500 USD 100
Personal Accident (Only 50% of the sum assured in respect of the death of the insured person below age of 18 U S D 1 5 0 0 0 ­
years)
AD & D Common Carrier USD 2500 ­
Loss Of Checked Baggage (Per Baggage maximum 50% and per item in the baggage maximum 10%) USD 500 ­
Delay Of Baggage USD 100 12 Hrs
Loss Of Passport USD 250 USD 25
Hijack USD 50 Per Day To Max USD 300 ­
Trip Delay USD 20 Per 12 Hrs To Max USD 12 Hrs
120
Personal Liability USD 100000 USD 100
Emergency Cash Advance (includes delivery charges) USD 500 ­
Golfer Hole­In­One USD 250 ­
Trip Cancellation USD 500 ­
Home Burglary Insurance INR 100000 ­
Trip Curtailment USD 200 ­
Hospitalization Daily Allowance USD 25 Per Day to Max USD 100 ­
Special terms & condition: This policy covers Medical Expenses arising out of Covid­19 outside India,including Medical Expenses incurred during Quarantine period
subject to the policy terms and conditions. Accommodation and non­medical incidental expenses arising during Quarantine period stand excluded.

Base Premium: 2660.17

Integrated GST @ 18%: 478.83
Total Premium: 3139.00
Policy Issuance Date: 30­Jun­2023
Policy Period: From : 25­Aug­2023 To : 26­Nov­2023
24Hours Helpline : Telephone No.: +91 124 4343838
Claims and policy Assistance Email : travel@allianz.com
Address of Notification of Claims : 1st Floor, DLF Square, M­Block, Jacaranda Marg, Phase­II, Gurgaon, Haryana ­ 1220022

IMPORTANT: Always and COMPULSORILY frst contact the 24 hours helpline and seek prior authorization from HELP LINE before incurring any expense. For all claims
please quote the claims authorization number and submit claim forms with original medical bills. The coverage provided is subject to details and declaration in the
proposal form and attached policy wordings
For & on behalf of Bajaj Allianz General Insurance Co. Ltd

Authorized Signatory
DECLARATION BY THE INSURED: We understand that this policy has been issued based on the information provided by us/our representative and the policy is not
valid if any of the information provided is incorrect. We also understand that this policy does not cover preexisting illnesses or disability or conditions arising there
from as per terms and conditions mentioned in the policy wordings.

Regd. Office : GE Plaza, Airport Road, Pune (India)

Service Tax Reg. No.: AABCB57530GST001
BAGIC GST No.: 07AABCB5730G1ZZ Signature of Insured