COMPREHENSIVE TRAVEL PROTECTION

TRAVEL PROTECTION CARD

NAME : MR xxxxxxx A S S I S T N O.
110xxxxx094

ADDRESS : SHIVA PALACE SANGTRASHAN BAZAR PAHAR S TA RT D AT E E N D D AT E

GANJ DELHI-110055 xx/xx/2xxx xx/xx/xxxx

SMART

Assist Fees : 4561( Incl GST @ 18% )

You can now enjoy exclusive travel assistance including insurance benefits on your trip. Kindly
ensure to carry this document for a pleasant travel experience.

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TRAVEL ASSISTANCE TRAVEL INSURANCE

24x7 Medical Lifestyle Domestic Roadside Arranged with an IRDAI authorised underwriter - ICICI
Assistance Assistance Assistance Lombard General Insurance Company Ltd.

Travel Support Services

Emergency Assistance Expert Intensive Care & Consultation 24/7 Customer Helpline

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Note: Assistance provided by Segura Services Pvt.
24x7 helpline: +91 22 67872 037
Ltd., Insurance underwritten by ICICI Lombard
Assistance: customercare@asego.in General Insurance Company Ltd.
Claims: claims@asego.in Customer will bear any cost or expenses arising
from availing the assistance services through a
Whatsapp message only for claims: +91 86478 34444 third par ty service provider.

www.asegotravel.com

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 ICICI LOMBARD GENERAL INSURANCE COMPANY LTD.
ICICI Lombard House, 414, Veer Savarkar Marg, Prabhadevi,Mumbai – 400025
IRDAI Registration No: 115
Telephone: 18001032292
Certificate Of Insurance

We would like to inform you that Bharti AXA General Insurance has merged with ICICI Lombard General Insurance w.e.f. Sept
8,2021. Enjoy our seamless services while exploring our enhanced offerings and diverse non-life insurance solutions

Customer Details:
Insured Name :MR xxxxx Date of Birth:xxxxxxx Passport Number:xxxxxxx
Address :SHIVA PALACE SANGTRASHAN BAZAR PAHAR GANJ DELHI DELHI-110055
Travel Assure - Group Overseas Travel Insurance Mobile no :9958471452 Landline no :9958471452
E Mail :multipledel@gmail.com CR no :
Issue Date :27/08/2022

Certificate No :SXxxxxxx094 Intermediary Code :22011224

Travel Assure - Group Overseas Travel Insurance Intermediary Name : Segura Services Private Limited
T h i s Gro u p Travel In s u ran ce p o l i cy I6894099 d ated 01- 04- 2022 h a s b een i s s u ed at Mu mb ai by IC IC I L o mb ard Gen eral In s u ran ce C o mp any Ltd . to th e master p o l i cy h o l d er,
S egu ra S er vi ces Pri vate L i mi ted . an d govern ed by th e terms , co n d i ti o n s a n d excl u s i o n s th erei n co ntai n ed o r o th er wi s e ex p res s ed i n th e s ai d certi f i cate, b u t n o t exceed i n g th e
S u m In s u red as s p eci f i ed i n th e S ch ed u l e. T h i s C erti f i cate, i s s u ed u n d er th e facs i mi l e s i gn atu re o f IC IC I L o mb ard Gen eral In s u ran ce C o mp any Ltd . rep res ents th e avai l a b i l i ty o f
b en ef i t to th e a b ove menti o n ed In s u red Pers o n . T h ro u gh th e master p o l i cy h o l d er IC IC I L o mb ard Gen eral In s u ran ce C o mp any Ltd . h as recei ved an amo u nt o f Rs . 1240. 00 ( In cl
GST @ 18%) towa rd s coveri n g th e ri s k b en ef i ts , o n b eh a l f o f th e a b ove menti o n ed i n s u red .

Insurance Details :
Commencement Date:From: 25/09/2022 End Date: mid-night on: :24/09/2023 No. of Days:365
Plan Name :N Multi Trip B-1 (30 Days)- Geographical Coverage :Including USA and CANADA (Worldwide)
Assignee 250000 :MR MD xxxxx Relation :Father
Exclusions :

Coverages Sum Insured Deductibles Coverages Sum Insured Deductibles

Emergency Medical Expenses Emergency
Medical Evacuation Repatriation of Mortal USD 250000 USD 100 Dental Treatment Expenses USD 250 USD 50
remains
Personal Accident
Accidental Death
USD 10000 NA Total Loss of checked - in Baggage USD 1000 NA
Permanent Total Disability(PTD)
Permanent Partial Disability(PPD)
Delay of Checked-in Baggage USD 150 12 HRS Loss of Passport and documents USD 250 USD 25
USD 75 per
Personal Liability USD 200000 USD 100 Hijack Distress Allowance day upto 4 12 HRS
days
Accidental Death -Common Carrier
USD 25 per
Permanent Total Disability-Common Carrier
Daily Allowance in case of Hospitalization day upto 5 2 Days USD 2500 NA
Permanent partial Disability -Common
days
Carrier
Bounced Hotel Booking USD 1000 USD 100 Child Escort USD 500 NA
Trip Cancellation and/or Interruption USD 1000 USD 100 Missed connection USD 500 3 HRS
USD 100 per
Trip Delay day upto 1 6 HRS Home Burglary Insurance (Contents) INR 200000 NA
day
Loss of International Driving Licence USD 500 USD 50 Loss of Gadgets USD 1000 USD 100
Car Rental Excess Insurance USD 500 USD
This policy covers adventure sports upto the limits specified under 'Other Terms & Conditions' and will be a part of Emergency Medical Expenses sum
insured
Emergency Assistance Details :
In case of a claim, you may reach us at 844-691-8883 (For Canada), 844-691-8885 (For USA) or +91 11 42221403 (For other parts of the world) or email
us at customersupportba@icicilombard.com.
Other Terms & Conditions :
• This policy covers Emergency Medical Expenses incurred due to sudden and unexpected injury or any acute Sickness including COVID-19, arising when insured
is outside the 'Republic of India' up to the limits as mentioned in the policy schedule.
• This Travel Insurance policy is only limited to customers of Segura Services Private Limited.
• Certificate is only valid to the customers who are travelling from India.
• This policy covers the insured if travelling to any Schengen & its associate countries up to the Sum insured of EUR 30000 minus deductible (if any).
• This policy consist of following coverage’s which will be treated as benefit covers i.e. Personal Accident- Accidental Death Permanent Total Disability (PTD)
Permanent Partial Disability (PPD), Accidental Death—Common Carrier, Permanent Total Disability - Common ,Permanent Partial Disability - Common carrier,
Daily Allowance in case of Hospitalization, and Hijack Distress Allowance subject to policy terms and conditions applicable to these sections. All others
coverage’s will be treated as indemnity.
• Sum insured for Emergency Medical Evacuation and Repatriation of mortal remains will be sublimited to sum insured specified in Emergency Medical Expenses.
• Pre-existing condition(s) are excluded from the policy including but not limited to unforeseen emergency measures to save the Insured/Insured person’s life.
This exclusion will apply to the following sections: Emergency Medical Expenses, Emergency Medical Evacuation, Dental Treatment Expenses, Daily Allowance in
case of Hospitalization, Permanent Total Disability (PTD), Permanent Partial Disability (PPD). This exclusion has been waived to the extent of USD 10000 per
policy or upto 10% of Sum Insured whichever is lesser as indicated in the Policy Certificate for mentioned section..
• Any claim arising out of sporting activities in so far as they involve the training or participation in competitions of professional or semi-professional sports
persons, Adventure Sports is not covered This exclusion has been waived to the extent of USD 20000 per policy if specifically opted or mentioned above.
• Sanctions Limitation and Exclusion Clause: Not applicable for sanctioned countries listed in certificate of insurance.
• No (re)insurer shall be deemed to provide cover and no (re)insurer shall be liable to pay any claim or provide any benefit hereunder to the extent that the
prevision of such cover, payment or such claim or provision of such benefit would expose that (re)insurer to any sanction, prohibition or restriction under United
Nations resolutions or the trade or economic sanction, laws or regulations of the European Union, United Kingdom or United States of America. Excluding
from/to and or countries places prohibited by GOI & also Specifically Excluding Iran I Iraq/Syria/ Sudan/ North Korea/Cuba/Crimea.
• Below Sublimit is applicable for the age above 60 Years upto the age of 80 years for Emergency Medical Expenses.
Sublim it Applicable - Above 60 Ye ars- 80 Ye ars
Ro o m Rent i n cl u d i n g Bo a rd i n g l o d gi n g $1500/ d ay u p to 30 d ays
Inten s i ve C are u n i t $3000/ d ay u p to 7 d ays
O p erati o n T h eatre ch a rges ( In cl u s i ve s u rgeo n ch arges ) ” Max i mu m Up to US D 10000
An esth eti st s er vi ces Up to 25% o f S u rgi ca l Treatment
Phys i ci a n V i s i t Max $ 75/ d ay u p to 10 vi s i ts
D i a gn o sti c an d Ra d i o l o gy s er vi ces Max u p to US D 1000
Amb u l a n ce S er vi ces Max u p to $ 500
H o s p i ta l Mi s cel l a n eo u s E x p en s es Max i mu m o f US D 1000
• Above mentioned sub limits are not applicable for Emergency medical Expenses section if sublimit waiver has been opted by insured & clearly mentioned on
above coverage section
• Sublimit applicable for age group above 80 years upto the age of 85 years & only limited to Emergency Medical Expenses is restricted to USD 5000 per illness &
Injury.
• Subject to the terms, conditions and exclusions of the ICICI Lombard General Insurance Company Ltd.

Au th o ri s ed S i gn ato r y
S ca n th e co d e o f au th enti cate ( IC IC I L o mb ard Gen era l
p o l i cy In s u ra n ce C o mp a ny Ltd . )
The certificate 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 mentioned in the policy.
• • Treatment a b ro a d i f th at i s th e s o l e reas o n o r o n e o f th e reas o n s fo r th e In s u red / In s u red p ers o n 's temp o ra r y stay
a b ro ad • Any cl ai m i f th e In s u red Pers o n 1. Is travel l i n g agai n st th e ad vi ce o f a Med i ca l Practi ti o n er;2. Is recei vi n g , o r i s
o n a wai ti n g l i st to recei ve, s p eci f i ed med i cal treatment d ecl a red i n th e Med i cal Pra cti ti o n er ’s rep o rt o r certi f i cate;

• H as recei ved termi n aIp ro gn o s i s fo r a med i cal co n d i ti o n ; Is ta ki n g p art i n a n avaI, mi l i tar y o r ai r fo rce O p erati o n . •
1 Gen era l E xcl u s i o n s
C o n gen i ta l ex tern a l d i s eas es , d el ects o r a n o mal i es • D i s ea s es , i l l n es s an d acci d ents th at are res u l ts o f wa r an d wa rl i ke
o ccu rren ce o r i nvas i o n , acts o f fo rei gn en emi es , h o sti l i ti es , ci vi l wa r, reb el l i o n , i n s u rrecti o n , ci vi l co mmo ti o n a s s u mi n g
th e p ro p o rti o n s o f o r a mo u nti n g to an u p ri s i n g , mi l i tar y o r u s u rp ed p ower, a cti ve p arti ci p ati o n i n ri o ts , co nf i s cati o n o r
n ati o n a l i zati o n o r req u i s i ti o n o f o r d estru cti o n o f o r d amage to p ro p erty by o r u n d er th e o rd er o f any govern ment o r
l o cal au th o ri ty.
Fo r a ny cl a i m rel ated q u er y, i nti mati o n o f cl a i m a n d s u b mi s s i o n o f cl a i m rel ated d o cu ments yo u may co ntact o u r
E mergen cy As s i sta n ce S er vi ce Provi d er.
In cas e o f a cl a i m, yo u may reach u s at 844- 691- 8883 ( Fo r C a n ad a ) , 844- 691- 8885 ( Fo r USA) o r + 91 11 42221403 ( Fo r
2 No ti ce o f C l a i m o th er p a rts o f th e wo rl d ) o r emai l u s at cu sto mers u p p o rtb a @ i ci ci l o mb ard . co m
Al tern ati vel y yo u can co ntact u s th ro u gh : To l l F ree - 1800- 103- 2292
E ma i l - cu sto mers u p p o rtb a @ i ci ci l o mb a rd . co m Po st/co u ri er to C o mp a ny - IC IC I L o mb a rd Gen eral In s u ran ce C o mp a ny Ltd . ,
IC IC I Ba n k Tower, Pl o t No . 12, F i n an ci al D i stri ct, Nan akram Gu d a,Ga ch i b owl i , H yd erab ad - 500032
C laim s P roc e dure
1. In th e event o f a n a cci d ent o r s u d d en i l l n es s wh i ch i s l i kel y to gi ve ri s e to a cl ai m u n d er th i s Po l i cy, th e In s u red Pers o n
s h a l l i mmed i atel y co nta ct th e E mergen cy As s i sta n ce S er vi ce Provi d er gi vi n g d etai l s o f th e Po l i cy i s s u ed to h i m/ h er. T h e
d eta i l s o f p h o n e n u mb ers an d H el p L i n e are gi ven i n th e No ti ce o f cl a i m s ecti o n .
2. Al l n eces s a r y cl a i m d o cu ments s h o u l d b e f u rn i s h ed to th e C o mp any/ E mergen cy As s i sta n ce S er vi ce Provi d er by th e
p o l i cy h o l d er/ i n s u red to make a cl a i m. H owever, cl ai ms f i l ed even b eyo n d s u ch p eri o d s h o u l d b e co n s i d ered i f th ere a re
va l i d rea s o n s o f any d el ay.
3 C laim P roc e dure & D o cu mentati o n 3. C l ai m S er vi ce Gu a ra ntee: T h e C o mp a ny s h al l s ettl e th e cl a i m wi th i n 30 d ays f ro m th e d ate o f recei pt o f l a st n eces s a r y
d o cu ment i n acco rd a n ce wi th th e p rovi s i o n o f regu l ati o n 27 o f IRDAI ( H ea l th In s u ran ce) Regu l ati o n s , 2016. In th e ca s e o f
d el ay i n th e p ayment o f a cl ai m, th e C o mp any s h al l b e l i ab l e to p ay i nterest f ro m th e d ate o f recei pt o f l a st n eces s a r y
d o cu ment to th e d ate o f p ayment o f cl ai m at a rate 2% ab ove th e b a n k rate
C laim s D oc um e ntation-
• D u l y f i l l ed i n a n d s i gn ed cl ai m fo rm• C erti f i cate o f In s u ra n ce • Any ad d i ti o n a l d o cu ment rel eva nt to cl a i m an d s p eci f i ed
i n th e Po l i cy wo rd i n gs T h i s i s o n l y a s u mmar y o f th e p ro d u ct featu res . T h e a ctu a l b en ef i ts ava i l ab l e are as d es cri b ed i n
th e p o l i cy wo rd i n gs a n d wi l l b e s u b j ect to th e p o l i cy terms , co n d i ti o n s a n d excl u s i o n s .
Fo r D etai l ed Terms & C o n d i ti o n s o f yo u r Travel In s u ran ce Po l i cy Ki n d l y C l i ck h ere
o r p a ste th e l i n k "https :/ /a s ego . co /a s ego travel / n ew/ Travel - As s u re- Gro u p - O vers eas - Travel - In s u ran ce- Po l i cy- Wo rd i n gs . p d f " o n yo u r b rows er.
Webs i te: w w w. b h arti - axagi . co . i n ; IRDAI Regi strati o n No : 115, E mai l :cu sto mers u p p o rtb a @ i ci ci l o mb a rd . co m
IC IC I L o mb a rd Gen era l In s u ra n ce C o mp a ny Ltd . ,, IC IC I L o mb ard H o u s e, 414, Veer S ava rkar Marg , Pra b h ad evi ,Mu mb ai – 400025
UIN: IC ITGO P22203V 022122, C IN:L 67200MH 2000PLC 129408