CIN No.

U66010RJ2006PLC029979 SHRIRAM GENERAL INSURANCE COMPANY LIMITED

IRDA Registration Number: 137
IN PARTNERSHIP WITH THE Sanlam GROUP
Regd. & Corpt. Office: E-8, EPIP, RIICO INDUSTRIAL AREA, SITAPURA
JAIPUR (Rajasthan) - 302022
Website: www.shriramgi.com
E-mail: customer.feedback@shriramgi.in
Toll Free: 1800-100-3009, 1800-300-30000, ISO/IEC 27001:2013 certified

PA Insurance for E-Ticket Passengers of IRCTC

Certificate of Insurance

Master Policy No: 10031/48/18/000001 Certificate No: 201707300032376

Name and Address of the Group Indian Railway Catering and Tourism Corporation 12th floor,
Organizer/Group Policy holder IRCTC Corporate Office Statesman House, Barakhamba Road,
New Delhi, Pin Code 110001.

Originating Station: DARBHANGA JN Destination Station: VARANASI CITY

Trip# details : Departure date and time: 01/08/2017 13:10:00 Arrival date and time: 01/08/2017 22:58:00

#Trip means the actual departure of train from the originating station to actual arrival of train at the destination station as
mentioned in booked ticket through which insurance cover has been opted and premium paid, including process of
entrainingand process of detrainingthe train. For other T&C and Policy wording please visit our website
www.shriramgi.com

Insured Details
PNR NO. 6204356035
Name Age Gender Mobile No. Email ID
Mr. DEEPAK KUMAR 18 Male 8709182103 dk5159@outlook.com

Nominee Details*
Name of Nominee Age Relationship with Insured

* In case if nominee details have not been provided then claim will be payable to Legal heir.

Sum Insured (IN INR)

Death Permanent total Permanent partial Hospitalization Transportation of
disability disability upto expenses for Injury mortal remains
upto
1000000 1000000 750000 200000 10000

Please quote the PNR No. & Certificate Number in all your correspondence.

Premium: Premium for your travel insurance is paid by IRCTC in advance.

IN WITNESS WHEREOF, this Policy of Insurance has been signed on 30/07/2017

GST No.: 08AAKCS2509K1Z3 PAN Number: AAKCS2509K

For Shriram General Insurance Company Limited.

Duly Authorized Signatory

Shriram General Insurance Co. Ltd.

CIN No. U66010RJ2006PLC029979 SHRIRAM GENERAL INSURANCE COMPANY LIMITED
IRDA Registration Number: 137
IN PARTNERSHIP WITH THE Sanlam GROUP
Regd. & Corpt. Office: E-8, EPIP, RIICO INDUSTRIAL AREA, SITAPURA
JAIPUR (Rajasthan) - 302022
Website: www.shriramgi.com
E-mail: customer.feedback@shriramgi.in
Toll Free: 1800-100-3009, 1800-300-30000, ISO/IEC 27001:2013 certified

PA Insurance for E-Ticket Passengers of IRCTC

Certificate of Insurance

Master Policy No: 10031/48/18/000001 Certificate No: 201707300032377

Name and Address of the Group Indian Railway Catering and Tourism Corporation 12th floor,
Organizer/Group Policy holder IRCTC Corporate Office Statesman House, Barakhamba Road,
New Delhi, Pin Code 110001.

Originating Station: DARBHANGA JN Destination Station: VARANASI CITY

Trip# details : Departure date and time: 01/08/2017 13:10:00 Arrival date and time: 01/08/2017 22:58:00

#Trip means the actual departure of train from the originating station to actual arrival of train at the destination station as
mentioned in booked ticket through which insurance cover has been opted and premium paid, including process of
entrainingand process of detrainingthe train. For other T&C and Policy wording please visit our website
www.shriramgi.com

Insured Details
PNR NO. 6204356035
Name Age Gender Mobile No. Email ID
Mr. RAGHVENDRA JHA 23 Male 8709182103 dk5159@outlook.com

Nominee Details*
Name of Nominee Age Relationship with Insured

* In case if nominee details have not been provided then claim will be payable to Legal heir.

Sum Insured (IN INR)

Death Permanent total Permanent partial Hospitalization Transportation of
disability disability upto expenses for Injury mortal remains
upto
1000000 1000000 750000 200000 10000

Please quote the PNR No. & Certificate Number in all your correspondence.

Premium: Premium for your travel insurance is paid by IRCTC in advance.

IN WITNESS WHEREOF, this Policy of Insurance has been signed on 30/07/2017

GST No.: 08AAKCS2509K1Z3 PAN Number: AAKCS2509K

For Shriram General Insurance Company Limited.

Duly Authorized Signatory

Shriram General Insurance Co. Ltd.