Bajaj Allianz General Insurance Company Ltd.

Regd.Office - GE Plaza, Airport Road, Yerwada, Pune - 411006 (India)

TRAVEL COMPANION IDENTIFICATION AND SCHEDULE
Reference No : Y
Policy No : OG-11-1104-9910-00002686 Imdcode : 10003484
Insurance Plan Chosen : TRAVEL ASIA SUPREME Subcode: 9906
Proposer Name : MRS VINAYASHREE KATTEKODI ANANDA Partner Id: 36168060
Date Of Birth: 27-MAR-1985 Geographical Coverage : ExcludingJapan
Home Address : KAVERI NO. 308 5TH MAIN 3RD CROSS 2ND BLOCK HRBR LAYOUT
KALYANANAGAR BANGALORE KARNATAKA
Pincode : 560043 Telephone Nos :
Passport No : G0743869 Assignee : BALASUBRAMANYA
JATHAHALLI
RAJEGOWDA
BENEFITS Limits (Max for entire policy period) DEDUCTIBLE
Medical Expenses,Evacuation and Repatriation USD 25000 USD 50
Personal Accident USD 7500 NIL
Loss of Checked Baggage USD 200 NIL
Delay of Checked Baggage USD 100 12 Hrs
Loss of Passport USD 100 USD 15
Personal Liability USD 10000 USD 100
Hijack USD 20 per day to max $ 200 NIL
Base Premium (in Rupees) : 356
Service Tax (in Rupees) : 36
Edu Cess (in Rupees) : 1
Total Premium (in Rupees) : 393
Date of Purchase of Policy : 30-SEP-2010
Policy Period : From 02-OCT-2010 to 08-OCT-2010 Or Date of return of Insured.

Claims Assistance Department : Health Administration Team

24 hours Helpline : Telephone No +91 20 3030 5858,Fax No: +91 20 3051 2207
Email : travel@bajajallianz.co.in
Address of Notification of Claims : Bajaj Allianz General Insurance Company Limited,
Ground Floor, Ashoka Plaza, 32/2, Nagar Road, Nr. Weikfield Company, Pune 411014
IMPORTANT : The policy coverages are as per the policy terms and conditions mentioned in the Travel Kit provided with this policy schedule.
You may refer the same on our website as well. Always and COMPULSORILY first contact the 24 hours helpline and obtain prior notification
number from HELP LINE before incurring any expense. For all claims Please quote the claims notification number and submit claim forms with
original medical bills. The coverage provided is subject to details and declaration in the proposal form given prior to taking this policy and
attached policy wordings.
Extension Process :
In case of any claim, please contact our 24 Hour Call centre at 1800-22-5858, 1800-102-5858 (Toll Free) / 91-020-30305858
(chargeable, add area code before this number in case of mobile call) or email us at 'info@bajajallianz.co.in'.
For the extension of the policy seven days prior to the expiry date mentioned above. The payment for the extended period of insurance if granted
would be accepted only through credit card. The policy may or may not be extended and is at the sole discretion of the Company as per
applicable underwriting guidelines prevalent.
For & on behalf of Bajaj Allianz General Insurance Cos. Ltd.

Authorized Signatory
Regd Office : GE Plaza,Airport Road,Pune(India)
ReceiptNo / Collection No / Amt(INR) := 0/0/393(INR) (If Premium is paid through cheque the policy is void ab-initio in case of dishonor of chq.)
Declaration by the insured : We understand that this policy has been issued based on the information provided by us/our representative
and the policy is not valid if any of the information provided is incorrect. We also understand that this policy does not cover any pre-existing
illness or disability or conditions arising therefrom.

Policy is valid only if countersigned by the insured in the space above Signature of Insured
accepting this declaration

Service Tax Reg. No. : AABCB5730G-ST-001

" Terms, Conditions and exclusions as per applicable memos and policy clause attached"