??????????Bajaj Allianz General Insurance Company Ltd.
Regd.Office - GE Plaza, Airport Road, Yerwada, Pune - 411006
(India)CORPORATE TRAVEL COMPANION IDENTIFICATION AND SCHEDULE
Master Policy No : IC OG-15-1901-9911-00000041 Imdcode :
10008059Certificate No : OG-16-1901-7001-00002604 SubImd code :
0Insurance Plan Chosen : JPMORG -$100000 Geographical Coverage :
WORLDWIDEProposer Name : MR PARTH SHAH Partner Id: 67128046Address
: VENTURA BLD,FLOOR 04,HIRANANDANI BUSINESS PARK,POWAI,MUMBAI
Date Of Birth: 29-MAR-1991 Pincode : 400076Passport No :
L6944441Assignee : Ramnik Khimji ShahScrutiny No : 45137749
Application No :
BENEFITS Limits (Max for entire policy period) DEDUCTIBLELoss Of
Passport USD 250 USD 30Personal Accident USD 25,000 NILTravel
Expenses for Family Members (incase of emergency) USD 2000 NILLoss
of Laptop USD 1000 USD 50Medical Expenses, Evacuation &
Repatriation USD 1,00,000 USD 50Delay of Checked Baggage USD 200 12
HRSEmergency Hotel Accomodation for Family Members USD 2000 NILLoss
of Baggage and Personal Documents USD 300 USD 30Loss of Checked
Baggage (PER BAGGAGE MAX. COVER IS 50% & PERITEM 10% OF S.I)
USD 1000 NILPersonal Liability USD 1,00,000 USD 200(*Max. limit for
Emergency dental Treatment is USD 500 (included in Medical
Expenses))**Maximum liability per baggage is 50% of the limit and
maximum liab-ility per item in a baggage is 10% of the limit as
mentioned in the Schedule *** Reimbursement of Emergency Purchases
While Overseas OnlyDate of Purchase of Policy : 02-JUN-2015From
Commencement date: 06-JUN-2015To Expiry Date : 29-JUN-2015 Or Date
of return of Insured [Whichever is earlier].Claims Assistance
Department : Health Administration Team24 hours Helpline :
Telephone No +91 20 3030 5858,Fax No: +91 20 3051 2207Email :
[email protected] Servicing Office : Bajaj Allianz
General Insurance Company Limited,
Ground Floor, Ashoka Plaza, 32/2, Nagar Road, Nr. Weikfield
Company, Pune 411014IMPORTANT : The policy coverages are as per the
policy terms and conditions mentioned in the Travel Kit provided
with this policy schedule. You may referthe same on our website as
well. Always and COMPULSORILY first contact the 24 hours helpline
and obtain prior notification number from HELP LINE beforeincurring
any expense. For all claims Please quote the claims notification
number and submit claim forms with original medical bills. The
coverage providedis 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
'[email protected]'.For any claim or policy related
queries, please call us at +91 20 3030 5858(chargeable) or Toll
Free Nos. mentioned on the travel kit. Alternately you may mailus
your query at [email protected] & On Behalf of
Bajaj Allianz General Insurance Company Ltd.
StampDuty Rs.0.5
Authorized SignatoryConsolidated stamp Duty paid vide Receipt
No: .24 dated 21-APR-15
Regd Office : GE Plaza,Airport Road, Yerwada Pune-411006
(India)
ReceiptNo / Collection No / Amt(INR) := By Float No 10008059/
720(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 isnot
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 conditionsarising therefrom.
Policy is valid only if countersigned by the insured in the
space aboveaccepting this declaration
Signature of Insured
--------------------------------------------------------------------------------
List of Toll-Free number for CFT Master
Policy--------------------------------------------------------------------------------Australia(061)--
0011+800
10002005,USA(001)--18665876903,Canada(001)--18669143705.For
Counties
Austria(043),Belgium(032),Denmark(045),France(033),Germany(049),Hungary(036),Ireland(353),Italy(039),Malaysia(060),Netherlands(031),NewZealand(064),Norway(047),Philippines(063),Portugal(351),Spain(034),Sweden(046),Swizerland(041),UK(044)--00+800
10002005.For Countires Hong
Kong(852),Singapore(065),So.Korea(082)-Carrier
Tele,Thailand(066)--001+800 10002005.Finland(358)-Carrier
Elisa--999+800 10002005,Finland(358)-Carrier TS--990+800
10002005,Israel(972)--014+800 10002005.
Japan(081)-Carrier IDC--0061-010+800 10002005,Japan(081)-Carrier
KDD--001-010+800 10002005,Japan(081)-Carrier NTT--0033-010+800
10002005.Japan(081)-Carrier Tele--0041-010+800
10002005,So.Korea(082)-Carrier Daco--002+800 10002005.WHEN DIALING
A UNIVERSAL TOLL FREE NUMBER THE CALLER MUST FIRST DIAL THE
APPROPRIATE COUNTRY'S INT'L ACCESS CODE(+) AS ILLUSTRATED
ABOVE.
AGA Assistance (India) Pvt Ltd
Name: MR PARTH SHAH
Policy No: OG-16-1901-7001-00002604
DOB: 29-MAR-1991
Plan: JPMORG -$100000
Policy Period: 06-JUN-2015 To 29-JUN-2015 Or Date of re-turn of
Insured [Whichever is earlier].
BAJAJ ALLIANZ GENERAL INSURANCE CO. LTD CLAIM ASSISTANCE
E-CARD
Please produce this card at the time of Medical Assistance along
with valid Id proof.This card is valid only during Policy Term
mentioned hereinabove
AGA Assistance (India) Pvt Ltd
Local Address Details: 2805, North Parham Road,The world access
building, Richmond, VA.23294
Toll free Help-line numbers USA (001) 1866-587-6903 , CANADA
(001)1866-914-3705Toll free if called within India 1800-22-5858
Address details of First Floor, GE Plaza,BAJAJ ALLIANZ GENERAL
INSURANCE CO. LTD Airport Road, Yerwada, Pune. 411006
Address of AGA Assistance (India) Pvt Ltd AGA Services(India)
Private Limited, 1st Floor,AGA license No : U63040HR2007PTC041959
DLF Square, DLF City, Phase II,
M-Block Jacaranda Marg, Gurgaon-122002,Haryana, India
BAJAJ ALLIANZ GENERAL INSURANCE CO. LTD CLAIM ASSISTANCE
E-CARD
Please produce this card at the time of Medical Assistance along
with valid Id proof.This card is valid only during Policy Term
mentioned hereinabove
Generated by ms@jpmc com
