HDFC ERGO General Insurance Company Limited

Policy Schedule Policy No. 2919 1000 0754 7500 000

2919100007547500000

Travel Insurance Policy

Proposer Name MR. NEELESH SURESH TAMBE Correspondence NEEL NIKETAN RAMDAS SWAMI NAGAR TAKLI ROAD, Address BEHIND GANDHI NAGAR NASIK, MAHARASHTRA, 422006 Mobile 9920858379 Phone E Mail Insurance Plan Single Trip Inc USA / Canada (Worldwide) From Date & Time 100000 11/11/2013 00:01 hrs Period of Insurance Permanent Address

NEEL NIKETAN RAMDAS SWAMI NAGAR TAKLI ROAD, BEHIND GANDHI NAGAR NASIK, MAHARASHTRA, 422006 NEELESHTAMBE@GMAIL.COM Overseas Ph. No. Countries of Visit To Date & Time Operative Time* WorldWide 10/12/2013 Midnight As mentioned below

Maximum any one life limit (US$)

*Operative Time: A trip outside the territorial limits of the country of residence. The insurance starts from the time an Insured Person leaves the territorial limits of the country of residence, and ends when an Insured Person returns to the territorial limits of the country of residence.

Insured Person's Details & Sum Insured

Insureds Name NEELESH SURESH TAMBE Category Self Gender Male Date of Birth 07/07/1979 Passport No. F6275073 Nominee Name Venu suresh tambe Relationship Mother

Coverage Details
Benefits Emergency Medical Expenses(EME) Accidental Death - Common Carrier Permanent Disablement - Common Carrier Hospital Cash Emergency Dental Treatment Loss of Baggage & Personal Documents Medical Evacuation Loss of Checked Baggage Delay of Checked Baggage Accidental Death Permanent Disablement / Table B Personal Liability Financial Emergency Assistance Hijack Distress Allowance Flight Delay Hotel Accomodation Sum Insured (US$) 100000 5000 5000 $15 per day/Max 150 500 250 Included in EME 1000 200 15000 15000 100000 700 $75 per Day/Max 525 $10 per Hour/Max 120 3000 Deductible (US$) 100 Nil Nil 1 Day 150 30 Nil Max 50% Per Bag/10% Per Item 12 Hours/$10 per 8 Hours Nil Nil 200 Nil 1 Day 6 Hours Nil

Premium Details (`)

Basic Premium Loadings Service Tax (Including Education Cess & Higher Education Cess, wherever applicable) Total Premium 1,462.00 0.00 181.00 1,643.00

Payment Details
Cheque No./DD/Fund Transfer RT1310001311 Date 09/10/2013 Bank Name Drawn On HDFC Bank

Special Conditions

Exclusions

List of Endorsements
Endt No Description Effective Date

I f the premium i s not realised the policy shall be void from inception. The stamp duty of ` 0.50 paid by Demand Draft, vide Receipt/Challan no 30347 dated 10/12/2012 as prescribed in Government Notification Revenue and Forest Department No Mudrank 2004/4125/CR 690/M-1, dated 31/12/2004 . Policy Issuing Office: Mumbai For HDFC ERGO General Insurance Company Ltd.

Duly Constituted Attorney 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.

Corporate Off.: 6th Floor, Leela Business Park, Andheri-Kurla Road, Andheri(E), Mumbai 400 059. Toll-Free No.1800-2-700-700 Fax 91 22 66383699 care@hdfcergo.com www.hdfcergo.com Registered Off.: Ramon House, H.T.Parekh Marg, 169, Backbay Reclamation, Mumbai 400 020, India.

HDFC ERGO General Insurance Company Limited Frequently Asked Questions (FAQs) - Travel Insurance Policy

CAN THE TRAVEL POLICY BE EXTENDED?

Extensions are applicable to original policies of 30 days or more and provided only if the Policy is still in force. Please note that extension on a policy can be availed only once.

FOR HOW MANY DAYS CAN THE POLICIES BE EXTENDED?

The Policy may be extended maximum upto 180 Days. The total policy period including extension should not exceed 360 days.

HOW DO I EXTEND MY POLICY?

You can send a mail to care@hdfcergo.com. You will receive a revert from our end with the detailed procedure and the additional premium amount to be paid.

CAN THE POLICY BE CANCELLED?

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 incepted, a copy of all 40 pages of the passport needs to be submitted as proof. Cancellation charges of Rs. 250/shall be applicable and the balance shall be refunded.

CAN THE PLAN COVERAGE PERIOD BE REDUCED?

No, the plan coverage cannot be 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 care@hdfcergo.com. On receipt of the request the endorsement will be processed within 48 hours and the documents will be sent to your registered email address.

HOW TO CONTACT US?

Call Toll-free : 1800 2 700 700 / 1800 226 226 Fax : 022 6638 3669 E-Mail : care@hdfcergo.com Write to us at : HDFC ERGO General Insurance Company Limited (Corporate Office) 6th floor, Leela Business Park, Andheri Kurla Road, Andheri(East), Mumbai - 400 059

HOW DO I FILE A CLAIM?

In the event of a covered emergency and to register claims, call our International Emergency Service Provider, International SOS - 24 hour Helpline Centre and quote Policy Holders Name, Policy Number, Insurance Company, Passport Number when seeking assistance within 24 Hours. The contact details are: Land line: 011-41898872 Fax: 011-41898801 Email: hdfcergo@internationalsos.com Toll Free No. 1866 202 4700 (For USA Only)

WHERE CAN ONE AVAIL THE CLAIM FORMS?

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.

WHOM TO CONTACT IN CASE OF HOSPITALIZATION?

International SOS should be contacted for all claims. The contact details are as provided above.

WILL THE CLAIMS BE SETTLED ON MY RETURN TO INDIA?

Claims are settled on the receipt of original documents

WHAT DOES 'DEDUCTIBLE MEAN?

Deductible means the amount of a claim which has to be borne by the insured.

Manage Your Portfolio @ hdfcergo.com / Smartphones*

Add/View your policy details Register motor/health claims Track your claim status online

Change your personal details on the go Track your interactions on endorsement dispatch status Find branches, garages and cashless network hospitals Download IPO mobile application from IPO website post log in

* supports smart phones based on Blackberry, iPhone, Windows8, Android & Symbian platforms

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.

Corporate Off.: 6th Floor, Leela Business Park, Andheri-Kurla Road, Andheri(E), Mumbai 400 059. Toll-Free No.1800-2-700-700 Fax 91 22 66383699 care@hdfcergo.com www.hdfcergo.com Registered Off.: Ramon House, H.T.Parekh Marg, 169, Backbay Reclamation, Mumbai 400 020, India.