HDFC ERGO General Insurance Company Limited
2919201983590500000
Policy Schedule Policy No. 2919 2019 8359 0500 000 0
Customer Id:102003892952 Id:102003892952
Travel Insurance Policy
0 Proposer Name Corr. Address/ Place of Supply Mobile
MRS. ANILA THOMAS PARAPPILLY HOUSE MALAYATTOOR P O MALAYATTOOR ERNAKULAM ERNAKULAM, KERALA, 683587 Phone E Mail
PAN No. Permanent Address
PARAPPILLY HOUSE MALAYATTOOR P O MALAYATTOOR ERNAKULAM ERNAKULAM, KERALA, 683587 Overseas Ph. No. Policy Issuance Date 10/11/2017
Single Trip Excl USA / Canada Insurance Plan From Date & Time 15/12/2017 00:01 hrs Period of Insurance Maximum any one life limit (US$) 100000
0
CZECH REPUBLIC Countries of Visit To Date & Time 25/12/2017 Midnight Operative Time* As menti mentioned oned below below
*OperativeTime: *OperativeTime: A trip outside d e theterritoria theterritoriall limitsof thecountry thecountry of residence. d ence. Theinsuranc Theinsurancee startsfrom thetime an Insured Insured Personleavesthe territor territoriallimits iallimits of thecountry thecountry of residen residence,and ce,and ends whena n Insured Person returns to the territorial limits of the country of residence.
Insured Person's Details & Sum Insured Insured s Name ’
ANILA ANILA THOMAS THOMAS
Category Self
Gender Female
Date of Birth 25/04/1975 25/04/1975
Passport No.
Nominee Name
Relationship
R4920637 R4920637
THOMAS PARAPPILLY ANTHONY ANTHONY
SPOUSE
Coverage Details Benefits Emergency Medical Expenses(EME) Accident Accidental al Death Death Emergency Dental Treatment Accident Accidental al Death Death - Common Common Carri Carrier er Flight Delay Personal Liability Permanent Disablement Common carrier Hospital Cash Loss of Baggage & Personal Documents Medical Evacuation Repatriation Loss of Checked Baggage(Max 50% Per Bag/10% Per Item) Delay of Checked Baggage Permanent Disablement / Table B Hijack Distress Allowance Contingency Travel Benefits Financial Emergency Assistance
Sum Insured (US$) 100000 15000 500 5000 10 per hr/Max 120 100000 5000 15 per day/Max 150 250 Included in EME Included in EME 1000 200 15000 75 per day/Max 450 3000 700
Deductible (US$) 100 NIL 150 NIL 6 hours 200 NIL 1 day 30 NIL NIL NIL 12 hours, $10 per 8 hours NIL 1 day NIL NIL
Premium Details (`) Ba B asic Premium
790.00
Loadings
0.00 142.20
GST 18% : Central Tax 9% ( ` 71 ) + State Tax 9% ( ` 71) To Total Premium
932.00
Payment Details Cheque No./DD/Fund Transfer 386042
D at e 14/12/2017
Bank Name Idbi Bank
Special Conditions Invoice No.
201983590500000
HSN Code
9971
We shall not be liabl liablee to make any payment under this poli policy cy in conn connecti ection o n wit withh or in respec respectt of any Illne Illness ss or injur injuryy direct directly ly or indir indirect ectly ly cause causedd by or contri contributed b uted to by nuclea nuclearr weapons/ weapons/mat materi erials als or contributed to by or arising from from ionising radiation or contamination by radioactivity radioactivity by any nuclear fuel or from any nuclear waste or from the combustion combustion of nuclear fuel. If the premium is not realised the policy shall be void from inception. The stamp duty of ` 0.50 paid by Demand Draft, vide Receipt/Challan no 3640854201718 dated 25/10/2017 as prescribed in Government Notification Revenue and Forest Department No Mudrank 2004/4125/CR 690/M-1, dated 31/12/2004 , Goods & Services Tax Registration No: 32AABCL5045N1ZH . Goods and Services Tax for this invoice is not payable under reverse charge basis.
Branch :2ND : 2ND FLOO FLOOR, R, CHICA CHICAGO GO PLAZA PLAZA,, RAJAJI RAJAJI ROAD ROAD,, NEAR NEAR TO TO KSRTC KSRTC BUS STAN STAND D ERNAK ERNAKULAM ULAM,, 682035. 682035. Phone No. :+91-484-3934300 : +91-484-3934300 For HDFC ERGO General Insurance Company Ltd.
Agent Name :MABIN Agent Code :200400883639 Tel No. : 91-9745300350
Signature Not Verified*1* Digitally signed by Nagendra Saikumar Date: 2017.11.10 13:15:02 IST Reason: I'm the author Location: India #1#
Duly Constituted Attorney
*$*NAGENDRA_SAI#$# The Policy wording attached herewith includes all the standard coverage offered by the Company to its customers. Your entitlement for coverage/benefits shall be restricted to the coverage/benefits as mentioned in this policy schedule. For any clarification please call our toll free number.
Registered & Corporate Office: 1st Floor, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai - 400020. Policy Issuing/Customer Service Address: D-301, 3rd Floor, Floor, Eastern Business District ( Magnet Mall), LBS Marg, Bhandup (West). MUMBAI - 400078. Maharashtra. Toll Free : 1800-2-700-700 (Accessible from India only) | Fax : 91 22 6638 3699 |
[email protected] | www.hdfcergo.com CIN : U66030MH2007PLC177117 | UIN : HDFTIOP03001V010203.
IRDAI Reg No. 146.
1
HDFC ERGO General Insurance Company Limited Frequently Asked Question’s (FAQs) (FAQs) - Tr Travel avel Insurance Policy
CAN THE TRAVEL POLICY BE EXTENDED? The extension under the policy shall be provided subject to the following conditions: The original policy period has not expired There is no claim on the original policy The sum insured shall not be enhanced Declaration of good health shall be provided by the Insured Extension can be effected only once on the Polic y Extension premium has to be paid before actual extension is effected
FOR HOW MANY DAYS CAN THE POLICIES BE EXTENDED? ¡
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Single Trip Including USA/Canada (Worldwide) & Single Trip excluding USA/Canada: The Policy may be extended maximum upto 180 Days. The total policy period including extension should not exceed 360 days. Single Trip Asia excluding Japan: The Policy may be extended maximum upto 30 Days. The total policy period including extension should not exceed 60 days. Single Trip Family Floater excluding USA/Canada: The Policy may be extended maximum upto 60 Days. The total policy period including extension should not exceed 120 days.
HOW DO I EXTEND MY POLICY?
CAN THE POLICY BE CANCELLED?
Retail Travel policy can be extended online. This functionality is available under renewal section on the home page of our website. You can use the URL:https://netinsure.hdfcergo.com/OnlineProducts/TravelOnline/Calcul atePremium.aspx and select option "Want to extend current Travel Insurance Policy".
The policy may be cancelled via request on Email/Fax, The intimation of cancellation has to reach us latest upto 14 days from the inception date of the policy. If the policy has already i ncepted, a copy of all 40 pages of the passport needs to be submitted as a proof that the journey has not been undertaken. Cancellation charges of Rs. 250/- shall be applicable and the balance shall be refunded.
Alternatively, you can send a mail to to
[email protected]. You will receive a revert from our end with the detailed procedure and the additional prem ium amount to be paid.
CAN THE PLAN COVERAGE PERIOD BE REDUCED? No, the plan coverage cannot be reduced, reduced, irrespective of the fact whether journey has commenced or not.
WHOM DO I NEED TO CONTACT TO MAKE CHANGES OR CORRECTIONS IN MY POLICY? You can mark a mail to c
[email protected]. On receipt of the request the You endorsement will be processed within 48 hours and the documents will be sent to your registered email address.
CAN THE TRAVEL DATES BE CHANGED BEFORE POLICY START DATE? Yes, provided there is no change in Health status as declared in the proposal form/online purchase. However, reduction in number of travel days is not allowed.
HOW TO CONTACT US?
HOW DO I FILE A CLAIM?
Call Toll-free: 1800 2 700 700 (Accessible from India only) Fax: 022-66383669 E-Mail:
[email protected] Write to us at : HDFC ERGO General Insurance Company Limited (Customer Service Office) 6th Floor, Leela Business Park, Andheri Kurla Road, Andheri (East), Mumbai - 400 059
In the event of a covered emergency and to register claims, call our 24 hour Helpline Centre and quote Policy Holders’ Name, Policy Number, Insurance Company, Passport Number when seeking assistance within 24 Hours.
Land line: + 91 - 120 - 4507250 (Chargeable) Fax: + 91 - 120 - 6691600 Email: travelclaims@hdfcergo
[email protected] .com Toll free fr ee No. + 800 08250825
WHERE CAN ONE AVAIL THE CLAIM FORMS?
WHOM TO CONTACT IN CASE OF HOSPITALIZATION?
On registration of a claim, claim form will be forwarded to you by mail, email or fax along with the intimation for the various documents required. The forms are also available on the website.
HDFC ERGO should be contacted for all claims. The contact details are as provided above.
WILL THE CLAIMS BE SETTLED ON MY RETURN TO INDIA?
WHAT DOES 'DEDUCTIBLE’ MEAN?
Claims are settled on the receipt of original documents
Deductible means the amount of a claim which has to be borne by the insured.
Convenience at your fingertips On the Customer Support section of our website, you can:
`
Get Policy Copy/ 80D Tax Certificate
Make Changes on Policy
Track Claim Status
Update Contact Details
This document is a summary of the benefits offered. The information mentioned above is illustrative and not exhaustive. Information must be read in conjunction with the policy wordings. In case of any conflict between this document and the policy wordings, the terms and conditions mentioned in the policy wordings shall prevail.
7 1 G U A . r e V
