IFFCO-TOKIO GENERAL INSURANCE CO. LTD.

Regd. Office : IFFCO Sadan, C1 Distt. Centre, Saket, New Delhi 110017
Servicing Office: 5th Floor, SONA Complex, Opp. M Ward Office, 1st Road, Chembur, Mumbai 400071
CIN U74899DL2000PLC107621, IRDA Licence No. 106

SCHEDULE - CUM - TAX INVOICE

PRAVASI BHARTIYA BIMA YOJANA POLICY 2017
Bill To RATIPAL NISHAD Place of Supply Maharashtra
Billing Address : AS PER PASSPORT, , , BASTI-272129 UTTAR MEA License No. :
PRADESH - 09 Indian R.A. GST No. :
Policy / Invoice No.: 32836280 Bill Date 29/05/2024
Details of the Insured:
First Name : RATIPAL Last Name : NISHAD
Address : AS PER PASSPORT Date of Birth : 03/12/1988

BASTI - 272129 State : UTTAR PRADESH - 09

Mobile No. :
Passport No. : B9067339 Validity of Passport : 14/03/2034
Nominee's Name : ANITA NISHAD Nominee's Relation : Spouse

Period : 2 YEARS ; 00:00 Hrs on 29/05/2024 To Midnight of 28/05/2026

POLICY COVERAGE
Benefits Sum Insured

I) Personal Accident Covering Death & Permanent Total Disability Rs.10,00,000/-

II) Transportation and Airfare for Attendant Actual Ecomony Class Return Airfare for Attendant &
Actual Transportation cost of Mortal Remains
III) Hospitalization Expenses covering Injuries/Diseases Rs.1,00,000/- (upto Rs.50,000/- Per Hospitalization)
IV) Maternity Expenses Rs.35,000/- Normal, Rs.50,000/- Caesarean
V) Hospitalization Expenses of Insured's Family in India Rs.50,000/-
VI) Employment Contingencies Actual Economy Class Airfare
VII) Repatriation Expenses On Medical Grounds Actual Economy Class Airfare
VIII) Legal Costs Rs.45,000/-

Premium Details in Rs.

Basic Premium : 275.00 CGST-9%: 25.00 SGST-9%: 25.00 Total Invoice Value : 325.00

G.S.T. Regn. No. : 27AAACI7573H1ZC SAC - 00997133, Description of Services - General Insurance Services
We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is 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.
Special Condition :

* This Policy is valid for all emigrants who solicit the policy under provision of PBBY Notification 2017, irrespective of the passport category.
* This Policy has been issued based on the information provided by you and the policy will not be valid if any information provided is incorrect.
* The Insurance Cover is subject to the terms, conditions and exclusions of Pravasi Bharatiya Bima Yojana 2017.
* The intimation of accident/physical injury is to be sent to the insurer within 30 days from the date of accident.
* The documents for the claim are to be submitted to the insurer within 90 days from the date of death/permanent disability.

For And on Behalf of IFFCO-TOKIO GENERAL INSURANCE CO. LTD.

Subrata Mondal

Date/Time of Issue : 29/05/2024 10:59:37 Authorised signatory

Consolidated Stamp Duty deposited as per the order of Government of National Capital Territory of Delhi
In case of any clarifications, Please call +91 022 25225902/25223217/25226208 or Write to IFFCO-TOKIO GENERAL INSURANCE CO.LTD.
Off. 5th Floor, SONA Complex, Opp. M Ward Office, 1st Road, Chembur, Mumbai 400071
Authenticity of this policy can be verified at http://pbby.iffcotokio.co.in (Policy query mode)