COMPREHENSIVE TRAVEL PROTECTION

TRAVEL PROTECTION CARD

NAME : PRAMOD KUMAR VASAVE KOLLAPPAGOWDA A S S I S T N O.

1100200192196

ADDRESS : IDA NACHARAM TELANGANA-500076 S TA RT D AT E E N D D AT E

10/07/2024 15/07/2024

SMART

Assist Fees : 875( 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

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Note: Assistance provided by ASEGO TRAVEL LLP,
24x7 helpline: +91 22 67872 037
Insurance underwritten by ICICI Lombard General
Assistance: customercare@asego.in 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.

asego.in

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 VOYAGER GROUP TRAVEL INSURANCE
PART I OF THE POLICY SCHEDULE
(UIN: ICITGBP22095V032122 )
Date:28/06/2024
To,
Pramod Kumar Vasave Kollappagowda
IDA NACHARAM TELANGANA-500076
7032993100
admin@iconlife.in

Dear Mr. / Ms. Pramod Kumar Vasave Kollappagowda,

Sub: Issuance of Policy Certificate no. 1100200192196 under your application for Group Travel Insurance Policy dated
28/06/2024
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 Pramod Kumar Vasave Kollappagowda

Domestic/Overseas Overseas

Geographical Scope Asia

No. of Travel Days 6

Countries being visited Asia

Period of Insurance Overseas - 10/07/2024 To 15/07/2024

Name of Pramod Kumar Vasave Date of Birth of

03/05/1994
Insured Kollappagowda Insured

PAN No. Passport No. of

V6504360
of Insured Insured

Relationship of Address of the IDA NACHARAM HYDERABAD

SELF
Insured with Proposer Insured TELANGANA-500076

Resident Country of issue of

Status Passport

Medical expenses due to Covid-19 is covered if contracted during the travel period as per policy terms and conditions.
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.
Thanking You,
Yours Sincerely,

Authorized Signatory,
ICICI LOMBARD GENERAL INSURANCE COMPANY LIMITED
ICICI Lombard General Insurance Company Limited (IRDAI Regn. No. : 115) CIN No. L67200MH2000PLC129408
Master Policy Number – 4168/O-TCAME/299925192/00/002 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-
TCAME/299925192/00/002 dated [masterpolicydate] has been issued at Mumbai, by ICICI Lombard General Insurance
Company Limited to the Policyholder, ASEGO Travel LLP 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 ASEGO Travel LLP 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: TCIL200192196

Mater Policy Number: 4168/O-TCAME/299925192/00/002

Issued At: Mumbai Stamp Duty: Rupee 1 /-

GSTN No: Invoice No:

Domestic/Overseas/Both: Overseas

Geographical Scope: Asia

Trip Details

Type of Trip For Overseas - Single-Trip

From 10/07/2024 To 15/07/2024 No. of Days 6

Details of Trip* 1 Place of
INDIA Destination Asia
Origin

Common
Carrier/Public
Carrier Opted

Adventure sports
Activities to be
undertaken while
on trip

Detailed Itinerary
Overseas
of the Trip*

Proposer/Policyholder Details

Name of the Proposer Pramod Kumar Vasave Kollappagowda

Insured Details

Name of the Insured Pramod Kumar Vasave Kollappagowda

Gender of the Insured MALE

Age as on Policy Start Date 30

Mailing address/Residential Address of the Insured IDA NACHARAM TELANGANA-500076

Occupation

Mobile Number 7032993100

Email ID admin@iconlife.in

Passport Number V6504360

ABHA No.

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

Politically Exposed Person (PEP)/close relative of PEP: No

Policy Details

Period of Insurance Overseas - From 10/07/2024 To 15/07/2024

Journey Start Date, if different from Policy Start Date

No. of Travel Days Overseas - 6

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
(Coverage Table to be customized in accordance to the Covers & Extensions opted)

Cover-specific
Section and Indemnity / Deductible, Franchise, Co-Pay, if
Sum Insured Condition,
Coverage Benefit if any if any any
if any

MEDICAL EXPENSES FOR HOSPITALIZATION

Hospitalization
Expenses for USD 75000 Indemnity 100 NA NA NA
Illness and Injury

Daily Allowance USD 25 per

in case of day for max Benefit 24 Hours NA NA NA
Hospitalization upto 5 days

Outpatient
USD 75000 Indemnity 100 NA NA NA
Treatment

OTHER MEDICAL COVERS

Medical
USD 75000 Indemnity 100 NA NA NA
Evacuation

Repatriation of
USD 75000 Indemnity NA NA NA
Remains

Dental Treatment USD 500 Indemnity 100 NA NA NA

NON-MEDICAL COVERS

Personal
USD 15000 Benefit NA NA NA
Accident

Loss of
Checked-in USD 500 Benefit NA NA NA
Baggage

Delay of
Checked-in USD 100 Benefit 12 HRS NA NA NA
Baggage

Loss of passport
and International USD 100 Benefit NA NA NA
driving license

Common Carrier
USD 50 Benefit 8 Hours NA NA NA
Delay

Financial
Emergency Cash USD 1000 Benefit NA NA NA
Allowance

Hijack Distress
USD 875 Benefit 12 Hours NA NA NA
Allowance

Damage to
baggage during USD 50 Benefit NA NA NA
Transit

Personal
Accident -
USD 15000 Benefit NA NA NA
Adventure sports
Level 1,2,3
 Cover-specific
Section and Indemnity / Deductible, Franchise, Co-Pay, if
Sum Insured Condition,
Coverage Benefit if any if any any
if any

Hospitalization
expenses for
Illness and Injury
USD 50000 Indemnity 250 NA NA NA
- Adventure
sports Level
1,2,3

Ext - Electronic
USD 200 Indemnity 100 NA NA NA
Equipment Loss

Trip Cancellation USD 1500 Indemnity 100 NA NA NA

Trip Interruption
USD 1500 Indemnity 100 NA NA NA
or Curtailment

Missed flight 3 Hours; Only

USD 500 Indemnity NA NA NA
connection Flights

Burglary (Home
USD 100000 Indemnity NA NA NA
Content)

Co-pay of 5% of
Personal Liability USD 200000 Indemnity NA NA NA
actuals

Hotel extension
due to USD 3000 Indemnity NA NA NA
contingency

Compassionate
USD 5000 Indemnity NA NA NA
Visit

Loss of Baggage
and Personal USD 500 Indemnity 100 NA NA NA
effects

Ext - Loss of
Electronic USD 200 Indemnity 100 NA NA NA
Equipment

Medical
Evacuation -
USD 15000 Indemnity 250 NA NA NA
Adventure sports
Level 1,2,3

Pre-existing USD Not

NA NA NA
Disease Cover Covered

Automatic
extension of
period of
USD 7 days Indemnity NA NA NA
insurance upto a
duration of
maximum

Premium Details

Net Premium (in ₹) ₹ 741.53

Applicable Taxes: (18 %) ₹ 133.47

 Premium Details
Total Premium (in ₹) ₹ 875

GSTIN of ICICI Lombard GIC 27AAACI7904G1ZN

HSN/SAC Code 997136/ GENERAL INSURANCE SERVICES

Servicing Branch: Mumbai

414, ICICI LOMBARD HOUSE, VEER SAVARKAR MARG,

Servicing Branch Address: 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 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.

The stamp duty of Rs.1 has been paid in cash or by demand draft or by pay order, vide Receipt/Challan no.CSD6920232872
dated 14/06/2023.
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.

Special Condition
Premium under this Master Policy is paid by the Master Policy Holder & the same is not recovered from the Insured

IMPORTANT NOTES:
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.
Insurance cover is subject to the terms and conditions mentioned in the Policy wordings provided to you with this Certificate.
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.
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.
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.
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; National Toll Free Number 1800 102 5721;
Rest of the World (Call Back Facility) +91 124 449 8778 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 IRDA Reg No : 115
Date : 28/06/2024 Misc Code : 168
 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
Medical Expenses for Hospitalization Expenses for Illness & Injury-
Illness & Accidental Reimbursement of expenses incurred in case
Injury of hospitalization due to illness contracted or
any Injury due to an Accident during the policy
period
Hospitalization Expenses for Illness & Injury-
Reimbursement of expenses incurred in case
of hospitalization due to illness contracted or
any Injury due to an Accident during the policy
period
Non Medical Covers Loss of Checked-In Baggage- Pro-rated
payout for pieces of baggage permanently lost
whilst under the custody of common carrier
vis-a-vis pieces of baggage that were
checked-in
Delay of Checked-In Baggage- Fixed payout
in case the checked-in baggage is delayed
beyond the period specified in policy
certificate
Loss of Baggage and Personal effects-
Reimbursement for loss of insured''s baggage
and personal effects due to theft, burglary,
larceny, robbery, hold-up or any such similar
events during the policy period
Personal Accident- Lump sum payout in case
of death or permanent total disablement or
permanent partial disablement of the insured
during the policy period
Trip Cancellation- Compensation for financial
loss (travel and accommodation) incurred on
cancellation of trip due to unexpected events
e.g. sickness, natural calamities, terrorist
attack etc.
Trip Interruption or Curtailment-
Compensation for the financial loss incurred
in case insured''s trip is interrupted and/or
insured need to curtail his/her trip due to
unexpected events beyond his/her control
Trip Resumption- Reimbursement of the cost
incurred towards resumption of a covered trip
that had to be curtailed due to unexpected
events beyond insured''s control
Operator Driven Common CarrierPublic
Carrier Cancellations- Fixed payout in the
event of ticket cancellations initiated by the
Common Carrier/Public Carrier
Common Carrier/Public Carrier delay- Fixed
payout in case of a delay in departure of the
scheduled Common Carrier/Public Carrier
Missed Connection (All Common
Carrier/Public Carrier)- Reimbursement for
official cancellation charges and additional
cost incurred to proceed with insured''s
planned trip in case he/she fails to access a
connecting flight or connecting Common
Some Of Major Exclusions Are -
* Any treatment that is not a part of the treatment
for injury or illness sustained during the policy
period * Routine physical
tests/vaccination/inoculations of any kind
* Any treatment that is not a part of the treatment
for injury or illness sustained during the policy
period * Routine physical
tests/vaccination/inoculations of any kind
* Losses dues to delay, detention, confiscation
by custom officials or other public authorities
* Delay resulting from detention/confiscation by
the common carrier or any authorized agency
* Any loss of partial Contents of the
baggage/hand baggage or cabin baggage except
for loss of sports equipment and/or loss of
electronic equipment and/or loss of valuables
* Death or Disability arising from or resulting
directly or indirectly from any illness * Amounts
related to medical expenses
* Any change of plans or dis-inclination on the
part of the insured resulting in cancellation of the
trip * In case of "Event cancellation" extension,
the event should not include personal family,
political, anti-national or any other event of
illegal nature
* Any change of plans or disinclination on your
part which are not results of any unforeseen
circumstances outside your control * Interruption
of the Trip either wholly or in part done at the
instance of the authority governing the Common
Carrier or the government
* Any change of plans or disinclination on your
part which are not results of any unforeseen
circumstances outside your control * Interruption
of the Trip either wholly or in part done at the
instance of the authority governing the Common
Carrier or the government
* Situations including but not limited to runway
closure, shutdown/in the process of shutdown of
airlines, advisory of Government to ban a certain
airline/aircraft etc. that may lead to recurring or
bulk cancellations will not be covered
* For any departure which is delayed as a result
of the insured or any other person accompanying
the Insured on the Trip
* For any departure which is delayed as a result
of the insured or any other person accompanying
the Insured on the Trip
Cover Name Covers In Brief Some Of Major Exclusions Are -
Carrier/Public Carrier due to a delayed arrival
of the previous Common Carrier/Public Carrier
Compassionate Visit- Reimbursement of Cost * Any reason mentioned as exclusion under
of visit (travel and accommodation) of a family covers-
member/friend to the insureds place of `Hospitalization Expenses for Injury" and/or
hospitalization for a specified duration if `Hospitalization Expenses for Illness and injury".
deemed necessary by the treating medical
practitioner
Hotel extension due to contingency- * Any other reason for extension other than the
Reimbursement of expenses towards lodging specific contingencies mentioned against this
and boarding for an extended stay at a pre- cover
booked hotel/accommodation facility if the
insureds departure is delayed due to
unexpected events beyond control
Other Medical Covers Repatriation of Remains- In the unfortunate * Death arising from intentional self-
event of the death of the insured, injury/suicide/attempted suicide
reimbursement of expenses incurred for
transporting the remains of the deceased
Insured back to the Country/Place of
Residence or for a local burial or cremation in
the country/place where death has occurred

Agent Details

Agent/Intermediary Name ASEGO INSURANCE LLP

Agent/Intermediary Code (ID) (AQ) IM-1870167

Agent/Intermediary Contact No. +91 22 67872 037

 Name : Pramod Kumar Vasave Kollappagowda
Policy No. : 1100200192196
Date of Birth : 03/05/1994
Valid From : 10/07/2024
Valid To : 15/07/2024

Please read the below mentioned information carefully for hassle free cliam
settlement

24*7 Customer Helpline Numbers for Claim Related Inquiry

1 Registration of claim is USA & Canada : +1

required prior to availing (Toll Free) 18448711200
benefits under this policy.

2 Please call the given numbers

Rest of The World : +91 124
(Toll Free) 4498778
to register your claim and to
cinfirm your coverage. India (Toll Free) : 18001025721
3 Cashless benefits are
applicable for Inpatient FAX Number : +91 124
treatment only and not for 4006674
Outpatient treatment.
Email Address :
4 This card is only for icicilombard@falck.com
information and does not
guarantee the admissibility of
claim.