Smart Traveller Insurance Policy (Individuals and Families)

Date : Wed, Nov 21, 2018 - 03:53 PM

Name of Policy Holder : Nairita Banerjee Policy No : SR627235
Communication Address : G6, Shriya SK Wonders, Near Masjid Banda, Kondapur,
Hyderabad, Telangana - 500084 Policy Type : SmartTraveller Basic- US$ 50K

Contact No. : 9676784719 Email ID : sagar.dce.ee@gmail.com Travel Start Date : Dec 22, 2018

Intermediary Details Geographical Coverage : Travel End Date : Dec 30, 2018
Name : POLICYBAZAAR Asia Excluding Japan Total No. of days : 9
INSURANCEWEB
AGG Branch Code : 2C
Contact No. : 9717567744
Code : : 2C000098

TRAVELLER DETAILS
Insured Insured Name DOB Passport Nominee
1 Nairita Banerjee Feb 20, 1990 K0998512 Madhura Banerjee

YOUR BENEFIT & PREMIUM DETAILS

Cover Sum Insured Deductible Cover Sum Insured Deductible
Medical Expenses(incl. repatriation & Emergency US$ 50000 US$ 50 Total loss of checked baggage* US$ 500 Nil
Medical Evacuation)

Dental Treatment Expenses US$ 500 US$ 50 Delay of checked baggage US$ 100 6 hours

Personal Accident US$ 15000 Nil Trip Delay US$ 50 6 hours

Accidental Death & US$ 2500 Nil Hijack Distress Allowance US$ 75 12 hours
Dismemberment (Common Carrier)

Compassionate visit Compassionate Nil Personal Liability US$ 50000 Nil

visit covered
Loss of Passport and documents US$ 350 US$ 25

Gross Premium (Rs.) 408.00

GST @18% 73.00

Total Premium (Rs.) 481.00

In case of a claim, you may reach us at 844-691-8883 (For Canada), 844-691-8885 (For USA) or +91 120 4593503 (For other parts of the world) or email us at claims@bharti-
axagi.co.in. We thank you for the patronage and confidence you have placed in us. We look forward to serve you again.

SANCTIONS LIMITATION AND EXCLUSION CLAUSE

No (re)insurer shall be deemed to provide cover and no (re)insurer shall be liable to pay any claim or provide any benefit hereunder to the extent that the provision of such
cover, payment or such claim or provision of such benefit would expose that (re)insurer to any sanction, prohibition or restriction under United Nations resolutions or the
trade or economic sanction, laws or regulations of the European Union, United Kingdom or United States of America. Excluding from/to and/or countries/places prohibited by
GOI & also Specifically Excluding Iran / North Korea / Sudan / Syria / Belarus / Cuba / Democratic Republic of Congo / Somalia / South Sudan / Zimbabwe / Russia / Crimea /
Eastern Ukraine / Nepal / Bangladesh / Iraq / Afghanistan / Angola / Ethiopia / Lebanon / Liberia / Libya / Nicaragua / Nigeria / Rwanda / Sierra Leone / Uganda / Myanmar / Yemen
/ Columbia / Bhutan.
This policy is booked via IP at Wed, Nov 21, 2018 - 03:53 PM SGT 2018 IST 2018
Best Regards,

Rohit Kohli
Vice President - Operations

The policy has been issued based on the information provided by you/your representative and the policy is not valid if any of the information provided is incorrect. Subject
otherwise to the Terms, Conditions and Exclusions mentioned in the policy. Actual departure date should not be more than 7 days from the date specified above. Returning
date is midnight or date of return of insured to India, whichever is earlier.

Policy Wordings

Tax Invoice will be followed after the Policy Certificate

Insurance is the subject matter of solicitation. For more details on risk factors, terms and conditions please read sales brochure of products carefully before concluding a sale. For redressal of
your grievance, if any, you may approach any one of the offices- 1.Policy issuing office 2.Corporate Office. In case, you are not satisfied with our own grievance redressal mechanism; you may
also approach Insurance Ombudsman. Details of Insurance Ombudsman offices are available at IRDA website: www.irda.gov.in , or on the website of General Insurance Council:
www.gicouncil.in or on the company website www.bharti-axagi.co.in
Bharti AXA GENERAL INSURANCE COMPANY LTD.
1st Floor, Ferns Icon, Survey No. 28, Doddanekundi, Bangalore 560037. INDIA. IRDA Regn.No.139 Tel: 91 80 40260100 Fax: 80 40260101 Email: Customer.service@bharti-axagi.co.in